ImportanceInterdisciplinary practice parameters recommend that patients with drug-resistant epilepsy (DRE) undergo comprehensive neurodiagnostic evaluation, including presurgical assessment. Reporting from specialized centers suggests long delays to referral and underuse of surgery; however, longitudinal data are limited to characterize neurodiagnostic evaluation among patients with DRE in more diverse US settings and populations.ObjectiveTo examine the rate and factors associated with neurodiagnostic studies and comprehensive evaluation among patients with DRE within 3 US cohorts.Design, Setting, and ParticipantsA retrospective cross-sectional study was conducted using the Observational Medical Outcomes Partnership Common Data Model including US multistate Medicaid data, commercial claims data, and Columbia University Medical Center (CUMC) electronic health record data. Patients meeting a validated computable phenotype algorithm for DRE between January 1, 2015, and April 1, 2020, were included. No eligible participants were excluded.ExposureDemographic and clinical variables were queried.Main Outcomes and MeasuresThe proportion of patients receiving a composite proxy for comprehensive neurodiagnostic evaluation, including (1) magnetic resonance or other advanced brain imaging, (2) video electroencephalography, and (3) neuropsychological evaluation within 2 years of meeting the inclusion criteria.ResultsA total of 33 542 patients with DRE were included in the Medicaid cohort, 22 496 in the commercial insurance cohort, and 2741 in the CUMC database. A total of 31 516 patients (53.6%) were women. The proportion of patients meeting the comprehensive evaluation main outcome in the Medicaid cohort was 4.5% (n = 1520); in the commercial insurance cohort, 8.0% (n = 1796); and in the CUMC cohort, 14.3% (n = 393). Video electroencephalography (24.9% Medicaid, 28.4% commercial, 63.2% CUMC) and magnetic resonance imaging of the brain (35.6% Medicaid, 43.4% commercial, 52.6% CUMC) were performed more regularly than neuropsychological evaluation (13.0% Medicaid, 16.6% commercial, 19.2% CUMC) or advanced imaging (3.2% Medicaid, 5.4% commercial, 13.1% CUMC). Factors independently associated with greater odds of evaluation across all 3 data sets included the number of inpatient and outpatient nonemergency epilepsy visits and focal rather than generalized epilepsy.Conclusions and RelevanceThe findings of this study suggest there is a gap in the use of diagnostic studies to evaluate patients with DRE. Care setting, insurance type, frequency of nonemergency visits, and epilepsy type are all associated with evaluation. A common data model can be used to measure adherence with best practices across a variety of observational data sources.

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推荐的神经诊断评估在耐药性癫痫患者中的应用

重要性跨学科实践参数建议耐药性癫痫 (DRE) 患者接受全面的神经诊断评估，包括术前评估。专业中心的报告表明，转诊的时间很长，手术的使用也不够充分；然而，纵向数据仅限于描述美国更多样化的环境和人群中 DRE 患者的神经诊断评估特征。目的检查 3 个美国队列中 DRE 患者的神经诊断研究和综合评估相关的比率和因素。设计、设置和参与者A回顾性横断面研究是使用观察性医疗结果合作伙伴通用数据模型进行的，包括美国多州医疗补助数据、商业索赔数据和哥伦比亚大学医学中心 (CUMC) 电子健康记录数据。 2015 年 1 月 1 日至 2020 年 4 月 1 日期间符合经验证的 DRE 可计算表型算法的患者均被纳入。没有排除符合条件的参与者。暴露人口统计学和临床​​变量被查询。主要结果和测量接受综合代理进行综合神经诊断评估的患者比例，包括（1）磁共振或其他先进的脑成像，（2）视频脑电图，和（3） ）满足纳入标准后2年内进行神经心理学评估。结果共有33 542名DRE患者被纳入医疗补助队列，22 496名患者被纳入商业保险队列，2741名患者被纳入CUMC数据库。共有 31 516 名患者（53.6%）为女性。医疗补助队列中满足综合评估主要结局的患者比例为 4.5% (n = 1520)；在商业保险群体中，8.0% (n = 1796)；在 CUMC 队列中，这一比例为 14.3% (n = 393)。视频脑电图（24.9% 医疗补助、28.4% 商业、63.2% CUMC）和脑部磁共振成像（35.6% 医疗补助、43.4% 商业、52.6% CUMC）比神经心理学评估（13.0% 医疗补助、16.6% 商业）更频繁地进行，19.2% CUMC）或高级成像（3.2% 医疗补助，5.4% 商业，13.1% CUMC）。与所有 3 个数据集的更大评估几率独立相关的因素包括住院和门诊非紧急癫痫就诊次数以及局灶性而非全身性癫痫的数量。结论和相关性本研究的结果表明，使用诊断研究来评估存在差距DRE 患者。护理环境、保险类型、非紧急就诊的频率和癫痫类型都与评估相关。通用数据模型可用于衡量各种观测数据源对最佳实践的遵守情况。