Quality Measures for the Care of Adult Patients with Restless Legs Syndrome

Abstract

The American Academy of Sleep Medicine (AASM) commissioned several Workgroups to develop quality measures for the care of patients with common sleep disorders, including adults with restless legs syndrome (RLS). Using the AASM process for quality measure development, the RLS Workgroup developed three target outcomes for RLS management, including improving the accuracy of diagnosis, reducing symptom severity, and minimizing treatment complications. Seven processes were developed to support these outcomes. To achieve the outcome of improving accuracy of diagnosis, the use of accepted diagnostic criteria and assessment of iron stores are recommended. To realize the outcome of decreasing symptom severity, routine assessment of severity and provision of evidence-based treatment are recommended.To support the outcome of minimizing treatment complications, counseling about potential side effects and assessing for augmentation and impulse control disorders, when indicated, are recommended. Further research is needed to validate optimal practice processes to achieve best outcomes in adult patients with RLS. Citation: Trotti LM, Goldstein CA, Harrod CG, Koo BB, Sharon D, Zak R, Chervin RD. Quality measures for the care of adult patients with restless legs syndrome. J Clin Sleep Med 2015;11(3):293-310.pii: jc-00027-15 http://dx.doi.org/10.5664/jcsm.4550 R estless legs syndrome (RLS), also referred to as WillisEkbom Disease (WED), is one of the most common sleep disorders, affecting between 5% and 10% of the United States population.1,2 RLS can adversely impact quality of life, disrupt sleep, impair daytime function, and impact mood. 1,[3][4][5][6] The delivery of high quality care for RLS depends on correct diagnosis, work-up for known comorbid conditions, delivery of appropriate evidence-based treatment, and follow up for treatment effectiveness and complications. 7 These aspects of RLS care may be subject to substantial practice variation, presenting opportunities for quality improvement.Ensuring quality healthcare is a priority within the American medical system. The promotion of high quality sleep care is central to the mission of the AASM, which seeks to "improve sleep health and promote high quality patient-centered care through advocacy, education, strategic research, and practice standards."8 To this end, the AASM commissioned Workgroups to develop quality care measures aimed at optimizing care for patients suffering from the most common sleep-related disorders, including adults with RLS. 9 These quality care measures focus on both outcomes, that is, what happens to a patient as a result of the care received, and processes, or the steps taken by a healthcare provider in the care of an individual patient. Both outcomes and processes are important in the care of the patient. Outcomes are often more directly relevant to the patient, whereas processes tend to be less infl uenced by factors outside an individual provider's control. All RLS outcomes and processes detailed in this report were developed by the RLS Quality ...

Toward a Definition of Quality Care for Patients with Restless Legs Syndrome

“…8 Despite the high volume of well-conducted research into RLS pathophysiology and treatment, research into processes and quality in RLS care is much less plentiful. The literature review was followed by Workgroup proposal of outcomes and associated process measures, refinement of these measures by the Workgroup, and feedback on measures from a larger group of AASM Quality Workgroups.…”

“…Full details regarding each measure and its specifications can be found elsewhere. 8 All final measures were approved by the AASM Board of Directors.…”

The Evolution of the AASM Clinical Practice Guidelines: Another Step Forward

“…In order to improve the quality of care given to patients with sleep disorders, clinicians must have valid, reliable, and practical tools to evaluate the effects of implementing recommended interventions and tests. The AASM, in consultation with numerous stakeholders, has developed Quality Measures for the diagnosis and management of several sleep disorders [20][21][22][23][24][25] ; many of these measures are based upon previously established clinical practice recommendations. Going forward, strong recommendations for or against a patient-care strategy will form the foundation of new quality measures, or be used to update existing quality measures.…”

Restless Legs Syndrome/Willis-Ekbom Disease Morbidity

“…This assessment can be accomplished either with validated scales or free text. 13 QOL plays such a large part in the disease of RLS that multiple scales to measure QOL and sleep quality have been developed and assessed specifically for RLS 14 (Box 1).…”