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Abstract Details

Housing Status and Healthcare Utilization in People Presenting with Seizures
Epilepsy/Clinical Neurophysiology (EEG)
P10 - Poster Session 10 (11:45 AM-12:45 PM)
1-004
To examine the association between housing status and healthcare utilization (length of stay, discharge disposition, 30-day re-visit) in individuals presenting to the hospital with a seizure.

Prior research suggests seizures commonly lead to hospitalization for people experiencing homelessness (PEH); however, little is known about the healthcare utilization in this population.
We performed a retrospective cross-sectional analysis of all patients presenting to the emergency room at a San Francisco County hospital between 1/1/2016-8/03/2019  with a primary diagnosis of seizure based on ICD-9 and 10 codes. We examined differences in comorbidities, demographics, and severity of presentation between housed individuals and PEH. To evaluate the association between housing status and utilization, we performed a multivariable linear regression for length of stay and multivariable logistic regression for discharge disposition (self-care vs. another facility) and 30-day re-visit adjusting for age, comorbidities, and insurance status.

The sample included 6483 individuals (2092 [32.3%] PEH). Compared to those housed, PEH were younger (48.2 years, p<0.0001), male (82.2%, p<0.0001), and had Medicaid (74.4%, p=0.0002). People with housing had higher prevalence of admission to the intensive care unit (3.6%, p<0.0001). In the fully adjusted model, PEH who were admitted to the hospital after seizure had higher odds of 30-day revisit (adjusted odds ratio [aOR] 1.87, 95% confidence interval [CI] 1.58, 2.21), shorter length of stay (coef B-12.87, 95% CI -22.62, -3.11), and lower odds of being discharged to a facility (aOR 0.37, 95% CI 0.26, 0.55) compared to those housed.

PEH with seizures had increased healthcare utilization with more 30-day re-visits, but paradoxically had lower lengths of stays and discharges to facilities. Further analysis including imaging findings, anti-seizure medications prescribed, and presumed etiology is needed to create a more nuanced understanding of healthcare utilization among PEH.
Authors/Disclosures
Nicole Rosendale, MD, FAAN (UCSF Dept of Neurology at ZSFG)
PRESENTER 		Dr. Rosendale has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. Dr. Rosendale has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. The institution of Dr. Rosendale has received research support from 好色先生. The institution of Dr. Rosendale has received research support from NIH StrokeNet Fellowship. The institution of Dr. Rosendale has received research support from The Dana Foundation. The institution of Dr. Rosendale has received research support from UArizona-Banner All of Us Seed Grant. Dr. Rosendale has received publishing royalties from a publication relating to health care.
Sandeepa Mullady, MD (Stanford University) Dr. Mullady has nothing to disclose.
Andrew Wood Andrew Wood has nothing to disclose.
Elan Guterman, MD (University of California, San Francisco) Dr. Guterman has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Guterman has stock in REMO Health. The institution of Dr. Guterman has received research support from NIH. The institution of Dr. Guterman has received research support from AAN.