Haneef Zulfi, Casanova Caleb A, Zhang Vincent, Bonds King Jennifer R, Rehman Rizwana, Garga Nina I, Graham Glenn D, Towne Alan R
Neurology Care Line, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
Mil Med. 2025 Jun 30;190(7-8):e1411-e1419. doi: 10.1093/milmed/usae526.
The Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) was established in 2008 to provide specialized care for veterans with epilepsy. Although established more than a decade ago, there has been no systematic evaluation of the ECoE's performance in key mission areas. We evaluated their performance in several key mission areas-clinical care, research, education, and outreach-since inception to evaluate their success in meeting the initial mandate.
We analyzed available data from relevant literature, ECoE annual reports, and the ECoE website between 2011 and 2023. Clinical care is the primary mission of the ECoE and was evaluated by examining utilization data for various clinical services and published literature. Research was assessed based on academic output and funding reported in the annual reports. Education and outreach were qualitatively assessed using recent data on the ECoE website and annual reports.
Total unique patient clinical visits for therapeutic/diagnostic encounters increased by 74% (from 10,487 in 2011 to 18,285 in 2023), which was nearly twice the 39.5% growth in workforce strength (from 119 in 2011 to 166 in 2022) over a similar period. Care provided by the ECoE is associated with decreased mortality rates compared to patients who do not receive ECoE neurology care. Tele-epilepsy visits increased considerably following the COVID-19 pandemic, from 1,928 in 2019 to 4,950 in 2021 (a 157% increase over 2 years). Research grant funding in fiscal year 2023 totaled approximately $4 million for ECoE-affiliated investigators. Outreach efforts included several VHA/non-VHA collaborations. The ECoE organizational structure was found to be highly interconnected and regionally represented, with special committees devoted to many key mission areas of epilepsy care.
Our analysis reveals progressive growth and improvements in the ECoE mission areas of clinical care, research, education, and outreach. Clinical utilization data have shown growth since inception, while also leading to lower mortality rates and lower costs per patient, fulfilling the organizational mandate to improve the care of veterans with epilepsy. There is substantial activity in research, education, and outreach. The ECoE governance hierarchy aims to facilitate smooth resource allocation both regionally and for the key mission areas. Our findings can help policymakers assess and prioritize future ECoE initiatives, while other clinical care organizations can seek to model their care based on the ECoE.
退伍军人健康管理局（VHA）卓越癫痫中心（ECoE）成立于2008年，旨在为患有癫痫的退伍军人提供专科护理。尽管该中心成立已超过十年，但尚未对其在关键任务领域的表现进行系统评估。我们评估了自成立以来该中心在几个关键任务领域——临床护理、研究、教育和外展——的表现，以评估其在完成初始任务方面的成功程度。
我们分析了2011年至2023年间来自相关文献、ECoE年度报告以及ECoE网站的可用数据。临床护理是ECoE的主要任务，通过检查各种临床服务的使用数据和已发表的文献进行评估。研究根据年度报告中报告的学术产出和资金进行评估。教育和外展则使用ECoE网站和年度报告中的最新数据进行定性评估。
治疗/诊断性就诊的独特患者总临床访视次数增加了74%（从2011年的10487次增加到2023年的18285次），这几乎是同期劳动力规模增长39.5%（从2011年的119人增加到2022年的166人）的两倍。与未接受ECoE神经科护理的患者相比，ECoE提供的护理与死亡率降低相关。COVID-19大流行后，远程癫痫就诊大幅增加，从2019年的1928次增加到2021年的4950次（两年内增长了157%）。2023财年，与ECoE相关的研究人员获得的研究资助总额约为400万美元。外展工作包括多项VHA/非VHA合作。发现ECoE的组织结构高度互联且具有区域代表性，设有专门委员会负责癫痫护理的许多关键任务领域。
我们的分析揭示了ECoE在临床护理、研究、教育和外展等任务领域的逐步增长和改善。临床使用数据自成立以来呈增长趋势，同时还降低了死亡率和每位患者的成本，实现了改善癫痫退伍军人护理的组织任务。在研究、教育和外展方面有大量活动。ECoE的治理层级旨在促进区域和关键任务领域的资源顺利分配。我们的研究结果可帮助政策制定者评估ECoE未来举措并确定其优先顺序，而其他临床护理组织可寻求以ECoE为榜样开展护理工作。
