MEDICAID ENROLLMENT PATTERNS AND SERVICE UTILIZATION OF EPILEPSY PATIENTS IN OHIO

Applying graphical, descriptive statistical, multiple failure survival, and causal inference methods on a large retrospective cohort of adults constructed from Ohio Medicaid administrative data base, we determined the optimal disease free period for identifying incident epilepsy cases, the magnitude and predictors of recurrent insurance gaps, and the causal effect of antiepileptic drug (AED) refill compliance on emergency department (ED) visit in the presence of insurance gaps.We identified three years as the optimum disease-free period for defining incident epilepsy cases in administrative data. About 28% of 45,654 persons with and 47% of 91,308 persons without epilepsy had insurance gaps during a median observation period of 84 and 62 months respectively. Disability eligibility, dual Medicaid-Medicare eligibility, managed care plan, nursing home residence, comorbidity, physician visit, and epilepsy were associated with reduced hazard rates of recurrent insurance gaps. Younger age, spend-down eligibility, and prior insurance gaps increased the hazard rate of recurrent gaps. About one quarter of person-months of observation were AED non-adherent and 12% had ED visits. The causal incidence ratios (95% confidence interval) of AED monthly noncompliance on overall and epilepsy related ED visit were 1.19 (1.18-1.20) and 1.15 (1.13-1.18) respectively. The AED noncompliance - overall ED visit causal effect was modified by age and comorbidity. The causal effects were similar whether all available data or only the first enrollment block was analyzed. In the sample of only the continuously insured, the causal effect estimates were slightly smaller and confidence intervals wider. We propose a 3 year disease-free period for defining incident epilepsy cases in administrative data. Medicaid program managers and policy makers should minimize insurance gaps, targeting younger adults, those without chronic illnesses, or after an index insurance gap. Health workers and care takers of people with epilepsy should ensure compliance with AEDs to avoid ED visit with the attending costs. When using administrative data, especially if the sample size is small, researchers should utilize all available data or censor study subjects at the first insurance gap rather than including only continuously insured subjects.2

Name thesis:degree_name

Doctor of Philosophy

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Epidemiology and Biostatistics

Grantor dc:publisher

Case Western Reserve University School of Graduate Studies

Year dc:date

2013

Author dc:creator

• Bakaki, Paul Mugeni

Contributors dc:contributor

• Albert, Jeffrey

• Epidemiology
• Health Care
• Neurology
• Public Health
• Statistics
• Medicaid Ohio Epilepsy Insurance Enrollment Gaps Disease-Free Adherence Compliance Antiepileptic Medications Emergency Room Department

Statement dc:rights

• unrestricted
• This thesis or dissertation is protected by copyright: some rights reserved. It is licensed for use under a Creative Commons license. Specific terms and permissions are available from this document's record in the OhioLINK ETD Center.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=case1365162793

OAI identifier oai:identifier

oai:etd.ohiolink.edu:case1365162793