Diagnostic tests and neurology care for Medicare beneficiaries with seizures: differences across racial groups.
BACKGROUND
Seizures and epilepsy are common in older adults especially in some minorities. Despite the importance of medical care to maximize seizure control, little is known about its quality across racial groups. One indicator of quality care is the receipt of electroencephalograms (EEG), and magnetic resonance imaging (MRIs) or computer tomography scans (CTs) after a first seizure. Neurologists' care is also important, given associated diagnosis and treatment challenges in older patients.


OBJECTIVE
To examine seizure-related care in the year after a first seizure for Medicare beneficiaries by race.


METHODS
Retrospective administrative claims analysis for 186,547 beneficiaries with claims for seizure or epilepsy in 2003-2005. Logistic regressions determined the association between care and race (White, Asian, African and Native Americans) adjusting for beneficiary, seizure, and community factors.


METHODS
EEGs, CTs or MRIs, and neurology visits.


RESULTS
About 60% received EEGs, 80% had MRIs or CT scans, and only 55.9% had an EEG and CT scan or an MRI. CT use (74%) was higher than MRI use (41%). About 79% had neurology visits. Compared with Whites, Native Americans were less likely to have neurology visits (66.9% vs. 78.8%; adjusted odds ratio: 0.72; 95% CI, 0.55-0.92). No clinically significant differences (>5%) were found for care received by other minorities compared with Whites.


CONCLUSIONS
Medicare beneficiaries with new-onset seizures commonly visit a neurologist, with some groups lagging behind. Use of some diagnostic tests is less common. Studies should continue investigating the quality of medical care for older adults with seizures.
Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-4410, USA. mpisu@uab.edu
Maria
M
Pisu
Joshua S
JS
Richman
Roy C
RC
Martin
Yongin
Y
Kim
Polly
P
Kratt
Kay
K
Clements
Ellen
E
Funkhouser
Robert
R
Knowlton
Edward
E
Faught
D000368:Aged; D000369:Aged, 80 and over; D003943:Diagnostic Techniques, Neurological / Q000706:statistics & numerical data*; D004569:Electroencephalography; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009462:Neurology / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D014481:United States