Association of Outpatient Follow-Up With 30-Day Readmission After Epilepsy or Seizure Discharge in Medicare Beneficiaries Aged 65 and Older

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Abstract
Older adults are expected to have higher readmission rates after seizure-related hospitalization. We sought to define the 30-day readmission rate for older adults after seizure hospitalization and to examine whether occurrence, timing, or specialization of follow-up with primary or neuro-related care is associated with lower readmission risk. This is a retrospective cohort study using 2016-2019 Medicare claims data, including adults aged older than 65 years hospitalized with a primary diagnosis of seizure/epilepsy. The primary outcome was readmission within 30 days. Exposure of interest was presence or absence of follow-up and specialty of the follow-up provider. Beneficiaries were followed from 90 days before admission to 30 days after discharge. We defined variables a priori based on literature/clinical judgment and used a least absolute shrinkage and selection operator (LASSO) method to determine factors that were contributing to the data's variance for inclusion in the final model. Of 80,620 beneficiaries with admissions for seizure/epilepsy, 17.72% were readmitted within 30 days. Overall, 20.6% saw only primary care, 2.5% neurology only, 0.3% neurosurgery only, and 0.1% epilepsy only, and 5.4% had a combination of visits. Readmission rates differed by follow-up visit status: 22% readmission rate for those with no follow-up and only 6% with any health care visit. Among those with a visit, the readmission rates by specialty were as follows: 8% for primary care alone, 5% for neurology alone, 16% for neurosurgery alone, 1% for epileptology alone, and 2% for those who had seen a combination of these specialties. In our LASSO-selected multivariable model, outpatient follow-up was associated with lower odds of readmission: early (days 1-15) primary care visit (adjusted odds ratio [aOR] 0.49; 95% CI 0.45-0.52, p < 0.001); early neurology visit (aOR 0.39; 95% CI 0.33-0.46, p < 0.001); and later (days 16-30) neurosurgery visit (aOR 0.42; 95% CI 0.27-0.67, p < 0.001), later neurology visit (aOR 0.16; 95% CI 0.13-0.21, p < 0.001), or later primary care visit (aOR 0.16; 95% CI 0.14-0.17, <0.001), all associated with reduced odds of readmission. We found high rates of readmission in older adults. Outpatient follow-up was associated with reduced odds of readmission. These findings reinforce the importance of discharge planning and suggest that ensuring outpatient follow-up with either primary care or neurology may be an easy intervention to reduce readmissions.

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