title: Hospital crossover increases utilization for people with epilepsy: a retrospective cohort study.
abstract: OBJECTIVE
  "Hospital crossover" occurs when people visit multiple hospitals for care, which may cause gaps in electronic health records. Although crossover is common among people with epilepsy, the effect on subsequent use of health services is unknown. Understanding this effect will help prioritize health care delivery innovations targeted for this population.
  
  
  METHODS
  We collected de-identified information from a health information exchange network describing 7,836 people with epilepsy who visited any of seven hospitals in New York, NY from 2009-2012. Data included demographics, comorbidities, and 2 years of visit information from ambulatory, inpatient, emergency department (ED), and radiology settings. We performed two complementary retrospective cohort analyses, in order to (1) illustrate the effect on a carefully selected subgroup, and (2) confirm the effect across the study population. First, we performed a matched cohort analysis on 410 pairs of individuals with and without hospital crossover in the baseline year. Second, we performed a propensity score odds weighted ordinal logistic regression analysis to estimate the effect across all 7,836 individuals. The outcomes were the use of six health services in the follow-up year.
  
  
  RESULTS
  In the matched pair analysis, baseline hospital crossover increased the odds of more visits in the ED (odds ratio 1.42, 95% confidence interval [CI] 1.05-1.95) and radiology settings (1.7, 1.22-2.38). The regression analysis confirmed the ED and radiology findings, and also suggested that crossover led to more inpatient admissions (1.35, 1.11-1.63), head CTs (1.44, 1.04-2), and brain MRIs (2.32, 1.59-3.37).
  
  
  CONCLUSIONS
  Baseline hospital crossover is an independent marker for subsequent increased health service use in multiple settings among people with epilepsy. Health care delivery innovations targeted for people with epilepsy who engage in hospital crossover should prioritize (1) sharing radiology images and reports (to reduce unnecessary radiology use, particularly head CTs), and (2) improving coordination of care (to reduce unnecessary ED and inpatient use).
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, U.S.A; Department of Pediatrics, Weill Cornell Medical College, New York, New York, U.S.A; Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, New York, U.S.A; New York Presbyterian Hospital, New York, New York, U.S.A.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Grinspan
authors.forename: Jason S
authors.initials: JS
authors.lastname: Shapiro
authors.forename: Erika L
authors.initials: EL
authors.lastname: Abramson
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Jung
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kern
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004827:Epilepsy; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Care coordination; Epilepsy; Health information exchange; Health information technology; Health services research