Abstracts

Rationale: The American Academy of Neurology published a set of 8 quality indicators for epilepsy management, intended for use in provider self-assessment and for guiding reimbursement. Pugh et al reported similar data showing 44% adherence to a related set of quality indicators at a tertiary center. We assessed the degree to which specific measures [(1) characterization of seizure type and frequency, (2) specific epilepsy diagnosis, and (3) availability of EEG information] are met in the comprehensive epilepsy clinics at the tertiary referral center at the Medical University of South Carolina (MUSC). Methods: We retrospectively identified outpatients seen by MUSC epilepsy providers between 1/1/2011 - 12/31/2011 that received an epilepsy ICD code (345.xx). From this population, we randomly selected subjects for chart abstraction. We determined the number of patients for whom there was adherence with quality indicators 1-3. Adherence was defined based on the descriptions published by the AAN. Subjects met criteria for indicator (1) when at least one seizure type was described AND seizure frequency was documented either quantitatively or qualitatively. Positive criteria for indicator (2) required documentation of etiology or specific epilepsy syndrome. Adherence with indicator (3) required documentation of results from a prior EEG or plans to obtain a future EEG. The number of patients meeting each indicator was identified. Results: 45 epilepsy patients (25 female) were identified with 69 visits. Mean age was 36 (range 7-75). 28 subjects had a single visit during the review period (range 1-3). Of 69 visits, 5 were new-patient appointments. Mean duration of epilepsy was 16.6 years (range 2 weeks -51 years). Eight providers were represented, with a mean of 8.5 visits per provider (range 1-20). INDICATOR 1: 33 of 45 subjects had at least one visit with both seizure type and frequency documented. Of 15 subjects with >1 visit, 7 had these documented at every visit. 12 subjects never had a visit with both seizure type and frequency documented. These 12 subjects also never had a documented reason for lacking this information. INDICATOR 2: 9 of 45 subjects had at least one visit that met positive criteria. Of 15 subjects with >1 visit, 1 met this at every visit. All 9 subjects had a specific epilepsy syndrome listed, and none referred to a specific etiology. INDICATOR 3: 33 of 45 subjects had either a prior EEG documented or orders for a future EEG. Of 15 subjects with >1 visit, 7 had these documented at every visit. While 12 of 45 subjects never had an EEG documented. Of these 12, none had a reason explaining the absence of EEG. Conclusions: Level of adherence with quality indicators at MUSC was in the range expected based on prior published reports. Further analysis with additional subjects is needed to determine the impact of these measures on the quality of care provided.