0546 An Informatics Approach to Assessing Quality of Care Metrics for Restless Legs Syndrome/Willis-Ekbom Disease

Abstract

Introduction Management of restless legs syndrome (RLS, aka Willis-Ekbom Disease) with dopaminergic agents is often complicated by development of augmentation. Clinical practice guidelines and stepwise algorithms suggest that prior to prescribing dopaminergic agents, clinicians should assess iron stores and consider alpha-2-delta agents (e.g. gabapentin). We developed an informatics approach to assess quality of care metrics for RLS management. Methods We used Veterans Affairs (VA) electronic health record data to identify a cohort of patients at a single tertiary care academic VA facility prescribed dopaminergic agents between 01 Jan 2018 to 31 Dec 2019. Patients with any prior codes for Parkinson’s disease were excluded. A random sample of charts were manually reviewed to determine if dopaminergic drugs were being prescribed for RLS or other indications. We then assessed for evidence of prior iron store assessments, iron repletion if appropriate, and alpha-2-delta agents (gabapentin, pregabalin). Results We identified 1160 patients treated with dopaminergic agents and no prior Parkinson’s codes. Chart reviews indicated 95% accuracy of this methodology to identify dopaminergic use for RLS. Evidence of pre-treatment iron storage assessment was missing in 30.2% for ferritin and 33.5% for transferrin saturation. Among those with iron studies present, lack of iron replacement was noted in 34% of those with ferritin <75 mcg/L and 33% of those with transferrin saturation <20%. Prior or concomitant prescriptions of alpha-2-delta agents was present in 59.7% of the cohort. Conclusion Our informatics approach provides an accurate and efficient means to quantify RLS care metrics. Results were most notable for a high proportion of dopaminergic-treated RLS patients without iron assessments and without iron repletion when stores were low. This methodology will inform future quality improvement initiatives to improve the delivery of guideline concordant RLS care. Support (If Any) This material is the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Health Care System, Minneapolis/USA.