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Diagnostic Tests and Neurology Care for Medicare Beneficiaries With Seizures: Differences Across Racial Groups

Pisu, Maria PhD*; Richman, Joshua S. MD, PhD; Martin, Roy C. PhD; Kim, Yongin PhD*; Kratt, Polly PhD, MSPH*; Clements, Kay BS§; Funkhouser, Ellen DrPH*; Knowlton, Robert MD, MSPH; Faught, Edward MD

doi: 10.1097/MLR.0b013e31824ebdc4
Original Articles

Background: Seizures and epilepsy are common in older adults especially in some minorities. Despite the importance of medical care to maximize seizure control, little is known about its quality across racial groups. One indicator of quality care is the receipt of electroencephalograms (EEG), and magnetic resonance imaging (MRIs) or computer tomography scans (CTs) after a first seizure. Neurologists’ care is also important, given associated diagnosis and treatment challenges in older patients.

Objective: To examine seizure-related care in the year after a first seizure for Medicare beneficiaries by race.

Research Design: Retrospective administrative claims analysis for 186,547 beneficiaries with claims for seizure or epilepsy in 2003–2005. Logistic regressions determined the association between care and race (White, Asian, African and Native Americans) adjusting for beneficiary, seizure, and community factors.

Measures: EEGs, CTs or MRIs, and neurology visits.

Results: About 60% received EEGs, 80% had MRIs or CT scans, and only 55.9% had an EEG and CT scan or an MRI. CT use (74%) was higher than MRI use (41%). About 79% had neurology visits. Compared with Whites, Native Americans were less likely to have neurology visits (66.9% vs. 78.8%; adjusted odds ratio: 0.72; 95% CI, 0.55–0.92). No clinically significant differences (>5%) were found for care received by other minorities compared with Whites.

Conclusions: Medicare beneficiaries with new-onset seizures commonly visit a neurologist, with some groups lagging behind. Use of some diagnostic tests is less common. Studies should continue investigating the quality of medical care for older adults with seizures.

*Department of Medicine, Division of Preventive Medicine

Department of Surgery, Division of General Surgery, Gastrointestinal Section

Neurology Chair Office

§Health Information Management Program, University of Alabama at Birmingham, Birmingham, AL

Department of Neurology, Emory University, Atlanta, GA

Supported under a cooperative agreement from the Centers for Disease Control and Prevention through the Association of American Medical Colleges, grant number U36/CCU319276, AAMC ID number MM-1042-08/08.

The authors declare no conflict of interest.

Reprints: Maria Pisu, PhD, Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1530-3rd Ave South, MT 636, Birmingham, AL 35294-4410. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.