Abstracts

Rationale: Using the American Academy of Neurology (ANN) Epilepsy Quality Measures (EQM) we assessed differences in quality of epilepsy care between two degrees of specialist involvement (neurologist involvement - NEU vs. epilepsy involvement - EPI). We then tested the hypothesis that quality care is associated with improved seizure control within a 24 follow-up months window, while controlling for degree of specialist involvement and epilepsy severity. Methods: This is a retrospective cohort study in which we performed a review from medical record of patients with epilepsy as a primary or secondary diagnosis (ICD-9 codes G40, 345.0-345.9), between 18 and 85 years old and with two or more visits to an outpatient neurology clinic. From the 1717 medical records identified, 338 where selected for analysis (figure 1). Baseline demographic and clinical information was compared using Chi square or Fisher exact test. The adherence of physicians to EQM was measured in three ways: As a binary defect free care measure; in which patients where given full credit for completing all of the EQM and no credit when some EQM was missed; as EQM total scores, where the sum of the scores in EQM were treated as continuous variables, EQM total score ranged from 0-1 and a t test was used to test the difference between means from EPI and NEU groups; and as EQM item by item, for this analysis the documentation of each individual EQM was considered binary (1= credit given, 0= no credit), either Chi square or Fisher exact test was used in this case for the comparison between group proportions. Seizure Control (SC) was defined as greater than 50% reduction in the average monthly seizure frequency before the third visit compared to the first visit. Regression model was performed to assess the relationship between EQM and seizure control (SC). Results: The proportion of patients who received defect-free care was higher in the EPI group (36.8%) than in the NEU group (16.7%) p=0.01. The mean EQM total scores were higher in the EPI group (83%, SD: 16%) than in the NEU group (66%, SD: 18%), p<0.001. EPI documented quality care with greater frequency than did NEU for specific documentation of seizure type and frequency, etiology or epilepsy syndrome, assessment of antiepileptic drug side effects, counseling about safety and care processes specific to women of child-bearing potential (EPI 55%, NEU 0%). The logistic regression model of SC as a function of EQM defect free metric suggested that adherence to EQM was not predictive of SC (p=0.10), while controlling for extent of subspecialty involvement and history of drug resistant epilepsy. Conclusions: In this study we found that even though epilepsy specialists are more adherent to the AAN EQM, greater adherence to this measures is not associated with seizure control. This study is limited by ceiling effect, as overall quality of care was high. A multicenter and prospective studies is necessary to further explore this relationship.