Abstracts

Rationale: In 2011, the AAN published Epilepsy Quality Measures to guide care for patients with epilepsy. Recognizing that significant treatment gaps existed in epilepsy care, with limited access to neurology specialists in some areas, the measures were written for both neurologists and primary care providers (PCPs). The Comprehensive Epilepsy Center at Children's Medical Center Dallas developed an educational initiative to assist PCPs in implementing the measures. The goal was to improve medical care for children with seizures before their first visit to the Epilepsy Center, and to engage PCPs as partners in the ongoing care of children with epilepsy. Methods: PCPs are asked to send medical records when referring children to the Epilepsy Center. In a preliminary needs assessment, PCP visit notes were reviewed for 266 children referred for new-onset seizures or epilepsy in 2013. 4 Epilepsy Quality Measures relevant to initial evaluation and care were assessed: Documentation of Seizure Type (i.e. physical description of the seizure), Request for EEG; Request for MRI of brain; and Epilepsy Safety Counseling. As notes may underestimate the teaching provided, any discussion of safety precautions or first aid measures (including advice to "call 911") was considered safety counseling. A "Toolkit" with management guidelines and patient educational material was developed to address the quality measures, and linked to 3 videotaped CME lectures. The Toolkit was sent to 1700 referring providers in 2014 and the lectures were made available on the Epilepsy Center website. 141 referrals were reviewed following the Toolkit mailing to determine changes in PCP practice. Results: PCPs are accustomed to providing safety education to families, but were deficient in epilepsy counseling. Given basic safety guidelines and educational handouts from the Toolkit, safety counseling increased dramatically. This suggests that PCPs are disposed to offer the information if given resources to do so. Although the Toolkit also outlined when to order an EEG or MRI, there was little increased use of these tests. This may reflect a relatively high initial referral rate for EEG (43%) due to previous Epilepsy Center efforts to encourage PCPs to order EEG along with initial referral. MRI scans are not always necessary for first seizures in children, explaining low utilization. The unexpected increase in seizure description may represent greater attention given to the seizure history following the Toolkit initiative. Conclusions: Providing PCPs with simple tools and management guidelines produced a dramatic increase in seizure safety counseling and may reduce epilepsy related injuries for children in our region. Encorporating electronic versions of seizure safety education in electronic health records commonly used by PCPs, and promoting their use, could have a widespread effect in protecting persons with epilepsy from injury. PCPs also appeared to take more detailed seizure histories following the Toolkit educational initiative, suggesting greater engagement in epilepsy care. Longer follow up is needed to determine whether these gains will be sustained over time.