Abstracts

Rationale: The EQM were first made available to clinicians in 2009 4, but their relationship to seizure control, patient centered outcomes and quality of life measures in people with epilepsy has yet to be demonstrated empirically. We assessed adherence to epilepsy quality measures (EQM) and whether adherence was associated with seizure control over a 2 to 3 –year follow-up, in a retrospective cohort study.Methods: A clinical data registry query identified 6150 patients from two large academic medical centers with a primary or secondary diagnosis of epilepsy who were 18-85 years old and seen in a general neurology or epilepsy outpatient setting between June 1, 2011 and May 31, 2014. Identified patients were further screened according to the following: initial visit to provider between July of 2011 and May 31st of 2012, treatment with ≥ one anti-seizure drugs, >1 visit per year over the review period, and seizure frequency documented at both the initial and final visit. This yielded 162 patients and 1055 visits from which socio-demographic, clinical and care quality data were abstracted. Quality care was assessed as (1) adherence to up to 8 eligible EQM, and (2) defect-free care (DFC) defined as adherence to all eligible EQM. Seizure control (SC) was defined as ≥ 50% reduction in average monthly seizure frequency between initial and final visits. Chi-square and t-test were used to compare care quality and seizure control. Logistic regression was used to analyze the relationships between SC and quality of care co-varying subspecialist involvement.Results: Quality of care defined as EQM metrics 1) documentation of seizure frequency, 2) discussion of intervention or intervention itself and 3) referral to a comprehensive epilepsy center, all exceeded 80% adherence. Documentation of: epilepsy etiology, seizure type or syndrome, side effects, epilepsy safety counseling, women’s counseling, 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 (=7.4%) and did not impact seizure control (p=0.75). 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) and specialty involvement does not significantly mediate the bivariate association of SC and overall mean EQM.Conclusions: Quality of care was modestly associated with seizure control in this retrospective cohort. Studies of EQM association with patient centered outcomes are needed.