Abstract Details

Title Adherence to AAN Guideline Recommendations That May Prolong Survival in ALS

Topic Anterior Horn

Presentation(s) P05 - (-)

Poster/Presentation
Number 079

Objective

Background BACKGROUND: In 2009, the AAN published updated evidence-based guidelines for the management of people with ALS. The Explorys Population Explore platform (Explorys, Inc., 2012) contains inpatient and outpatient information on more than 13 million subjects in a de-identified data platform drawn from multiple US hospital systems.

Design/Methods DESIGN/METHODS: Aggregate data were accessed in a HIPAA and HITECH compliant manner and mapped to a single set of UMLS ontologies and into SNOMED-CT hierarchy. Data were analyzed from 2680 patients with motor neuron disease (MND) from 2009 to the present. All group sizes were rounded to the nearest 10 subjects.

Results RESULTS: Since 2009, 20.5% of patients with MND received riluzole, 6.7% had a PEG tube, 7.1% received noninvasive ventilation, and 2.6% received invasive ventilation. Overall, age and gender were not associated with riluzole use, except for in younger vs. older men (OR=1.48; 95% confidence interval 1.14-1.92). Caucasian race was associated with use of riluzole (OR=1.81; 95% CI= 1.27-2.58), especially over age 65 (OR=3.09; 95% CI= 1.58-6.05). Medicare and private insurance patients were more likely to use riluzole compared to Medicaid patients (OR=3.97; 95% CI: 2.48-6.34).

Conclusions CONCLUSIONS: In the three years following publication of the guideline, the recommended interventions that may modestly extend life were not commonly used. Riluzole use is associated with younger age in men, Caucasian race, and use of private insurance or Medicare compared to Medicaid. Low levels of adherence may be due to the modesty of the benefit, patient preferences, lack of knowledge about the recommendations, or lack of physician belief in the efficacy of the interventions.

Authors/Disclosures
Wendy S. Edlund, MD PRESENTER	Dr. Edlund has a non-compensated relationship as a Member, Resident and Fellows Board with Journal of Child Neurology that is relevant to AAN interests or activities.
Tjalf Ziemssen, MD, FAAN (University Clinic Dresden)	Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS . Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for TEVA. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Dresden Internation University. The institution of Dr. Ziemssen has received research support from Novartis. The institution of Dr. Ziemssen has received research support from Merck. The institution of Dr. Ziemssen has received research support from Sanofi. The institution of Dr. Ziemssen has received research support from BMS. The institution of Dr. Ziemssen has received research support from Roche.
Christian E. Schenk, MD, FAAN (University of Puerto Rico)	Dr. Schenk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Schenk has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for RGR Law. Dr. Schenk has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for SIMED.
	No disclosure on file
	No disclosure on file
Alan Lerner, MD (University Hospitals Case Medical Center)	The institution of Dr. Lerner has received research support from Premier applied biosciences. Dr. Lerner has received publishing royalties from a publication relating to health care.
Richard H. Swartz, BSc MD PhD FRCPC (Sunnybrook Health Sciences Centre)	The institution of Dr. Swartz has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Swartz has received research support from Ontario Brain Institute.

��ɫ��

��ɫ��