Association of Outpatient Follow-Up With 30-Day Readmission After Epilepsy or Seizure Discharge in Medicare Beneficiaries Aged 65 and Older

BACKGROUND AND OBJECTIVES: Older adults are expected to have higher readmission rates after seizure-related hospitalization. We sought to define the 30-day readmission rate for older adults after seizure hospitalization and to examine whether occurrence, timing, or specialization of follow-up with primary or neuro-related care is associated with lower readmission risk. METHODS: This is a retrospective cohort study using 2016-2019 Medicare claims data, including adults aged older than 65 years hospitalized with a primary diagnosis of seizure/epilepsy. The primary outcome was readmission within 30 days. Exposure of interest was presence or absence of follow-up and specialty of the follow-up provider. Beneficiaries were followed from 90 days before admission to 30 days after discharge. We defined variables a priori based on literature/clinical judgment and used a least absolute shrinkage and selection operator (LASSO) method to determine factors that were contributing to the data's variance for inclusion in the final model. RESULTS: < 0.001), or later primary care visit (aOR 0.16; 95% CI 0.14-0.17, <0.001), all associated with reduced odds of readmission. DISCUSSION: We found high rates of readmission in older adults. Outpatient follow-up was associated with reduced odds of readmission. These findings reinforce the importance of discharge planning and suggest that ensuring outpatient follow-up with either primary care or neurology may be an easy intervention to reduce readmissions.