Evidence map›Paper›PMID 30674587›Full record

ArticleNeurology2019

Claims data analyses unable to properly characterize the value of neurologists in epilepsy care.

Chloe E Hill, Chun Chieh Lin, James F Burke, Kevin A Kerber, Lesli E Skolarus, Gregory J Esper, Brandon Magliocco, Brian C Callaghan

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
1.3field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 19 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Chloe E HillFrom the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN. chloehi@med.umich.edu.
Chun Chieh LinFrom the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN.
James F BurkeFrom the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN.
Kevin A KerberFrom the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN.
Lesli E SkolarusFrom the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN.
Gregory J EsperFrom the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN.
Brandon MaglioccoFrom the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN.
Brian C CallaghanFrom the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN.
Emory University · US

Funding

Implementation of Evidence-Based Practice for Benign Paroxysmal Positional VertigR01DC012760 · NIDCD · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI KERBER, KEVIN ANTHONY, MEURER, WILLIAM JOSEPH · 2013 to 2024
$6.2M
Reducing Racial Disparities in Post-Stroke Disability in the ElderlyR01MD008879 · NIMHD · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI BURKE, JAMES FRANCIS, SKOLARUS, LESLI ELIZABETH · 2014 to 2018
$1.9M
Solutions for Vertigo presentations in the Emergency Department (SOLVE) ProjectR18HS017690 · AHRQ · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI KERBER, KEVIN ANTHONY · 2009 to 2012
$1.5M
Self-Diagnosis and Treatment Tools for Benign Paroxysmal Positional VertigoR18HS022258 · AHRQ · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI KERBER, KEVIN ANTHONY · 2014 to 2018
$1.2M
Using Outcomes Analyses to Inform Implementation of NINDS Clinical TrialsK08NS082597 · NINDS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI BURKE, JAMES FRANCIS · 2013 to 2017
$948k
Dizziness in the Emergency Department: A Population-Based ProjectK23RR024009 · NCRR · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI KERBER, KEVIN ANTHONY · 2007 to 2011
$797k
AHRQ HHS R18 HS017690AHRQ HHS R18 HS022258NCRR NIH HHS K23 RR024009NIDCD NIH HHS R01 DC012760NIMHD NIH HHS R01 MD008879NINDS NIH HHS K08 NS082597
6 · The paper itself

Abstract

objectiveTo determine the association of a neurologist visit with health care use and cost outcomes for patients with incident epilepsy.

methodsUsing health care claims data for individuals insured by United Healthcare from 2001 to 2016, we identified patients with incident epilepsy. The population was defined by an epilepsy/convulsion diagnosis code (ICD codes 345.xx/780.3x, G40.xx/R56.xx), an antiepileptic prescription filled within the succeeding 2 years, and neither criterion met in the 2 preceding years. Cases were defined as patients who had a neurologist encounter for epilepsy within 1 year after an incident diagnosis; a control cohort was constructed with propensity score matching. Primary outcomes were emergency room (ER) visits and hospitalizations for epilepsy. Secondary outcomes included measures of cost (epilepsy related, not epilepsy related, and antiepileptic drugs) and care escalation (including EEG evaluation and epilepsy surgery).

resultsAfter participant identification and propensity score matching, there were 3,400 cases and 3,400 controls. Epilepsy-related ER visits were more likely for cases than controls (year 1: 5.9% vs 2.3%,

conclusionsPatients with epilepsy who visited a neurologist had greater subsequent health care use, medical costs, and care escalation than controls. This comparison using administrative claims is plausibly confounded by case disease severity, as suggested by higher nonepilepsy care costs. Linking patient-centered outcomes to claims data may provide the clinical resolution to assess care value within a heterogeneous population.

Indexed as

Ambulatory CareNeurologyAdministrative Claims, HealthcareAdultAgedAnticonvulsantsDisease ManagementEmergency Service, HospitalEpilepsyFemaleHealth Care CostsHealth ServicesHospitalizationHumansMaleMiddle AgedAnticonvulsantsEG 1088Quinazolines

Identifiers

PMID30674587
PMCPMC6404473
OpenAlexW2912922495

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.