Integrative Care Models in Neuropsychology: A National Academy of Neuropsychology Education Paper.

Although collaborative, and more specifically, integrated models of care have existed for years, the 2010 Patient Protection and Affordable Care Act expanded their use, and Medicare has adopted a value-based payment system that further emphasizes service provision within the collaborative health care setting. Neuropsychology as a field is well-situated to work within the integrated health care setting, which presents both opportunities and challenges for clinical neuropsychologists. This education paper details how different neuropsychology clinical practice settings fit into an integrated care framework; discusses challenges to service delivery and fiscal viability in such settings and other health care related settings; and examines future directions for the role of neuropsychology within a dynamic health care system.

Seizure severity is associated with quality of life independent of seizure frequency.

OBJECTIVE: The goal of the work described here was to determine whether seizure severity is associated with quality of life and if this association exists independent of seizure frequency. METHODS: We administered a survey questionnaire to patients followed at the Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville. RESULTS: The study population comprised 142 subjects. On univariate analysis, increased seizure severity (as measured with the revised Liverpool Seizure Severity Scale, LSSS) and seizure frequency were significantly associated with poorer Quality of Life in Epilepsy-10 (QOLIE-10) scores. Most items on the LSSS were significantly associated with QOLIE-10 scores, as well as the various scales of the QOLIE-10. Likewise, all QOLIE-10 scales were significantly associated with overall LSSS scores. The correlation between seizure severity and frequency was insignificant. On multiple linear regression, both seizure severity and frequency were independently associated with QOLIE-10 scores. CONCLUSION: Seizure severity is associated with quality of life and this association exists independent of seizure frequency.

The association between health literacy and outcomes of care among epilepsy patients.

PURPOSE: To determine the association between health literacy and outcomes of care (seizure control and quality of life) in individuals with epilepsy followed at a level four epilepsy center. METHODS: We conducted a face-to-face interview of patients seen at the Comprehensive Epilepsy Program of the University of Florida HSC/Jacksonville. We obtained demographic and clinical data, administered the Quality of Life in Epilepsy-10 inventory, and performed the Liverpool Seizure Severity Scale. We asked three screening questions taken from the Short Test of Functional Literacy in Adults. Using each health literacy question as the target variable we determined the predictor variables that were associated with responses to these questions and performed multiple linear regression to determine those that retained their significance. RESULTS: One hundred and forty adult patients with epilepsy comprised the study population. On univariate analysis, patients who did poorly on questions for health literacy that included "difficulty reading hospital materials" and "difficulty filling out medical forms" had lower scores on the QOLIE-10 and lower annual household incomes. This significance was maintained on multivariate analysis. Those who had problems learning about their medical condition due to difficulties understanding written information had poorer scores on the QOLIE-10, increased seizure frequency, and lower educational levels on univariate analysis. However, on multivariate analysis, only poorer scores on quality of life were independently significant. CONCLUSION: Patients with epilepsy who have limited health literacy do not necessarily have poorer seizure control but have lower quality of life scores.

Factors associated with utilization of healthcare resources among epilepsy patients.

PURPOSE: To determine those variables associated with utilization of healthcare resources in epilepsy patients. METHODS: We interviewed 256 epilepsy patients. Target variables included the number of clinic visits, ER visits and in-patient admissions over the past year and AEDs currently being used. Predictor variables were age, race/ethnicity, marital status, education, income, insurance, seizure frequency and QOLIE-10 results. We used univariate analysis to determine those factors associated with the target variables and multivariate analysis to ascertain those independently significant. RESULTS: On univariate analysis, higher seizure frequency and poorer QOLIE-10 scores were associated with the number of clinic visits, ER visits and in-patient admissions. Increased seizure frequency and male gender were associated with higher use of AEDs. Using ordinal logistic regression, QOLIE-10 scores was the only variable associated with the number of clinic visits. Both seizure frequency and QOLIE-10 scores were independently associated with the number of in-patient admissions while seizure frequency and male gender remained independently associated with AED use. Using binary logistic regression, QOLIE-10 scores and seizure frequency were independently associated with the number of ER visits. CONCLUSION: Seizure frequency and quality of life are major factors associated with utilization of healthcare resources in epilepsy patients.

Factors associated with satisfaction with care among patients with epilepsy.

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.