Lidia M V R Moura1, Diego Yacaman Mendez2, Jonathan De Jesus3, Rogger A Andrade4, Joel S Weissman5, Barbara G Vickrey6, Daniel B Hoch7. 1. Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: lidia.moura@mgh.harvard.edu. 2. Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: dymendez@partners.org. 3. Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: jdejesus5@partners.org. 4. Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: raandrade@partners.org. 5. Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA; Department of Health Policy and Management, Harvard T Chan School of Public Health, Boston, MA 02115, USA. Electronic address: jweissman@partners.org. 6. Department of Neurology, University of California, Los Angeles, CA 90095-1769, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. Electronic address: bvickrey@ucla.edu. 7. Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: dhoch@partners.org.
Abstract
OBJECTIVE: We assessed the relationship between adherence to epilepsy quality measures (EQM) and seizure control over 2-3 years in a retrospective cohort study. METHODS: 6150 patients were identified at two large academic medical centers with a primary or secondary diagnosis of epilepsy, were 18-85 years old and seen in outpatient general neurology or epilepsy units between June 2011 and May 2014. Patients were included if: their initial visit was between June 2011 and June 2012, treatment was with ≥1 anti-seizure drug, there was ≥1 visit per year during the timeframe, and seizure frequency was documented at initial and final visits, yielding 162 patients/1055 visits from which socio-demographic, clinical and care quality data were abstracted. Quality care was assessed as (1) percent adherence to up to 8 eligible EQM, and (2) defect-free care (DFC: adherence to all eligible EQM). Seizure control (SC) was defined as ≥50% reduction in average seizures/month between initial and final visits. Chi-square and t-test compared care quality with seizure control. Logistic regression was used to assess the relationships between SC, quality of care and subspecialist involvement. RESULTS: Care quality, reflected by documentation of seizure frequency, addressing therapeutic interventions, and referral to a comprehensive epilepsy center, all exceeded 80% adherence. Care quality as reflected by documentation of seizure type, etiology or syndrome; assessment of side effects, counseling about epilepsy safety and women's issues, and screening for psychiatric disorders ranged from 40 to 57%. Mean EQM adherence across all applicable measures was associated with greater seizure control (p=0.0098). DFC was low (=8%) and did not covary with seizure control (p=0.55). The SC and non-SC groups only differed on epilepsy etiology (p=0.04). Exploratory analysis showed that mean quality scores are associated with seizure control (OR=4.9 [1.3-18.5], p=0.017) while controlling for the effect of subspecialty involvement as a possible confounding variable. CONCLUSIONS: Average quality of care but not defect-free care was associated with seizure control in this retrospective cohort.
OBJECTIVE: We assessed the relationship between adherence to epilepsy quality measures (EQM) and seizure control over 2-3 years in a retrospective cohort study. METHODS: 6150 patients were identified at two large academic medical centers with a primary or secondary diagnosis of epilepsy, were 18-85 years old and seen in outpatient general neurology or epilepsy units between June 2011 and May 2014. Patients were included if: their initial visit was between June 2011 and June 2012, treatment was with ≥1 anti-seizure drug, there was ≥1 visit per year during the timeframe, and seizure frequency was documented at initial and final visits, yielding 162 patients/1055 visits from which socio-demographic, clinical and care quality data were abstracted. Quality care was assessed as (1) percent adherence to up to 8 eligible EQM, and (2) defect-free care (DFC: adherence to all eligible EQM). Seizure control (SC) was defined as ≥50% reduction in average seizures/month between initial and final visits. Chi-square and t-test compared care quality with seizure control. Logistic regression was used to assess the relationships between SC, quality of care and subspecialist involvement. RESULTS: Care quality, reflected by documentation of seizure frequency, addressing therapeutic interventions, and referral to a comprehensive epilepsy center, all exceeded 80% adherence. Care quality as reflected by documentation of seizure type, etiology or syndrome; assessment of side effects, counseling about epilepsy safety and women's issues, and screening for psychiatric disorders ranged from 40 to 57%. Mean EQM adherence across all applicable measures was associated with greater seizure control (p=0.0098). DFC was low (=8%) and did not covary with seizure control (p=0.55). The SC and non-SC groups only differed on epilepsy etiology (p=0.04). Exploratory analysis showed that mean quality scores are associated with seizure control (OR=4.9 [1.3-18.5], p=0.017) while controlling for the effect of subspecialty involvement as a possible confounding variable. CONCLUSIONS: Average quality of care but not defect-free care was associated with seizure control in this retrospective cohort.
Authors: Jerzy P Szaflarski; Roy C Martin; Edward Faught; Ellen Funkhouser; Joshua Richman; Kendra Piper; Lucia Juarez; Chen Dai; Maria Pisu Journal: Epilepsy Behav Date: 2017-04-12 Impact factor: 2.937
Authors: Lidia M V R Moura; Thiago S Carneiro; Andrew J Cole; John Hsu; Barbara G Vickrey; Daniel B Hoch Journal: Patient Prefer Adherence Date: 2016-10-31 Impact factor: 2.711
Authors: Felipe J S Jones; Jason R Smith; Neishay Ayub; Susan T Herman; Jeffrey R Buchhalter; Brandy E Fureman; Sydney S Cash; Daniel B Hoch; Lidia M V R Moura Journal: Neurology Date: 2020-06-16 Impact factor: 9.910