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2023 HSR&D/QUERI National Conference Abstract

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4008 — Veteran perspectives on quality of epilepsy care: Impact of Veteran satisfaction, knowledge, and proactivity.

Lead/Presenter: Samin Panahi,  COIN - Salt Lake City
All Authors: Panahi S (University of Utah, VA Salt Lake City Health Care System), Kennedy E ( University of Utah, VA Salt Lake City Health Care System) VanCott A (University of Pittsburgh, VA Pittsburgh Health Care System) Roghani A ( University of Utah, VA Salt Lake City Health Care System) Lopez MR (University of Miami, Miami VA Medical Center) Stromberg K( University of Utah, VA Salt Lake City Health Care System) Pugh MJ ( University of Utah, VA Salt Lake City Health Care System)

Objectives:
Veterans are at elevated risk of epilepsy in part due to higher rates of traumatic brain injury and other neurological disorders. However, little work has examined the extent to which quality of care is associated with other outcomes important to Veterans with epilepsy (VWE). Our goal was to examine the relationship between quality of care and patients’ knowledge of epilepsy self-care, proactive epilepsy self-management, and satisfaction, adjusting for care process factors and covariates.

Methods:
We conducted a national survey of post-9/11 Veterans with validated active epilepsy who received two or more years of VA care FY02-FY14; surveys were conducted September 2018-July2019. Veterans self-reported receipt of three care processes reflected in American Academy of Neurology epilepsy quality measures and one measure identified by Veterans in cognitive interviews (knowing when to seek emergency care). Outcome measures included epilepsy self-care knowledge, proactive epilepsy self-management, and satisfaction. Covariates included age, sex, race/ethnicity, education, employment, and a measure of patient-provider communication. An ordinary least-squares regression model was used to determine if quality of care was associated with proactive epilepsy self-management, epilepsy self-care knowledge, and satisfaction with care.

Results:
In our sample (n = 441) self-reported quality of care was associated with each outcome. Having provider guidance on when to seek emergency care was significantly associated with higher care satisfaction (0.11, P = 0.003). Having a provider who asked about seizure frequency since the last visit was positively associated with epilepsy self-care knowledge (0.15, P < 0.001). High quality patient-provider communication was associated with epilepsy self-care knowledge (0.22, P < 0.001) and proactive epilepsy self-management (0.34, P < 0.001). Further, Black VWE reported lower scores on epilepsy self-care knowledge compared to Whites (-0.41, P < 0.001).

Implications:
Prior studies of epilepsy quality of care have used health system data and medical chart abstraction, which reflect provider reported care processes. These data sources may not reflect quality measures that are not medication or procedure based but are important to Veteran outcomes. By linking Veteran self-reports of care quality with outcomes, we found that knowing when to seek emergency care and inquiring about seizure frequency were significant predictors of satisfaction and epilepsy self-care knowledge respectively. However, the strongest predictors of epilepsy self-care knowledge and proactive epilepsy self-management was patient-provider communication.

Impacts:
This analysis offers opportunities to improve the quality of epilepsy care through the practice of patient-centered care models. Prior studies have found that the black population is disadvantaged in receiving treatment such as epilepsy surgery mainly because of patients' lack of understanding of the therapy. This suggests that our finding regarding race and epilepsy self-care knowledge may be mitigated with interventions to improve patient-provider communication.