Quality improvement in neurology

Abstract

Epilepsy is a common condition in the United States. It is estimated that 1.2% of the population or 3.4 million people have epilepsy. This figure may be underestimated because of potential repercussions and stigma in disclosing epilepsy. 1 Studies have shown that people with epilepsy are more likely to be unemployed or unable to work, have lower annual household incomes, be obese and physically inactive, and be less likely to marry. 2,3 People with epilepsy can have poor overall health status, impaired intellectual and physical functioning, elevated risk of accidents and injuries, and negative side effects from antiseizure medications. 2,3 It is estimated the annual direct medical cost of epilepsy in the United States is $9.6 billion; combined with indirect costs, the total rises to $15.5 billion yearly. 2 The American Academy of Neurology (AAN) created standardized quality measures with the overarching goal to improve the delivery of care for patients with epilepsy for providers, practices, and systems. In 2009, the first set of epilepsy measures were released with an update provided in 2014. 4,5 Quality measures are not guidelines; however, they are formed using guidelines, evidence-based medicine, and best practice consensus. Quality measures help us understand how often health care services are provided consistent with current medical knowledge. Measures are updated iteratively to reflect evidence and practice changes, as well as to reflect limitations of data collection and analysis. The AAN reviews each measurement set for updates a minimum of every 3 years. In 2017, the AAN seated a standing multidisciplinary Epilepsy Quality Measurement Set Work Group (work group) charged with updating the measurement set. This work group will revisit the epilepsy measures every 6 months, evaluating new evidence statements and new measures released by other developers. As part of this process, epilepsy measure implementation and performance data review will also occur to nimbly respond to emerging guidelines and evidence. During this initial review, the work group evaluated new evidence, 2014 epilepsy measure use data, and other new measures released by other development groups that addressed care for patients with epilepsy, such as the AAN's Child Neurology and Universal Neurology Quality Measure projects. The work group approved 6 measures and retired 6 measures from the 2014 update (table 1). Measure retirement occurs if evidence has changed, a gap in performance no longer exists, feasibility concerns exist, or significant edits are needed to the existing measure. It does not mean the topic is no longer important.

Antiepileptic Drug Treatment Patterns in Women of Childbearing Age With Epilepsy

“…In addition, efforts to raise awareness of current American Academy of Neurology quality measures on the counseling of teratogenicity risk may assist in ensuring that the risk-benefit profiles of treatments are evaluated by both clinicians and patients. 48 Treatment patterns for women of childbearing age with epilepsy should continue to be monitored through population-based studies.…”

Quality Indicators of Pharmaceutical Care in Palestinian Integrative Healthcare Facilities: Findings of a Qualitative Study among Stakeholders

“…Healthcare facilities employing integrative medicine are no exception and measuring performance and provision of healthcare services have drawn considerable attention. Quality measures to be used in assessing performance of healthcare providers and delivery of services across the continuum of healthcare were developed [19,23]. In general, these quality measures might help ensure that services were provided consistently and efficiently [19,20,22].…”

Development and Evaluation of Computable Phenotypes in Pediatric Epilepsy:3 Cases

“…First, neonatal hypoxic-ischemic encephalopathy is a risk factor for infantile spasms and other epilepsies, but it is unclear how different treatment strategies for hypoxic-ischemic encephalopathy affect that risk. 9,10 Second, the American Academy of Neurology Epilepsy Quality Measure Set 11 suggests that individuals with treatment-resistant epilepsy should be evaluated by an epilepsy specialist, but it is unclear if treatment resistance 12 can be determined with sufficient reliability to support electronic reporting of this quality measure. Furthermore, identifying these patients is important because some may be candidates for dietary therapies, epilepsy surgery, or devices (ie, vagus nerve stimulator).…”