Abstracts

Rationale: The AAN published 8 epilepsy quality measures (Neurology 2011;76:94-99) to provide a guide to practicing neurologists by recommending preferred practices. We aimed to assess the difference in practice patterns of epileptologists and other neurologists in relation to the epilepsy quality metrics. Data on measures such as behavioral health, bone health and sudden unexplained death (SUDEP) were also collected.Methods: We retrospectively reviewed electronic clinic visit data in a random sample of epilepsy patients from 3/1/10 to 8/31/10. We collected demographics and AAN epilepsy quality measures that included seizure type/frequency, epilepsy syndrome/etiology, EEG, MRI/CT, drug side effects, referral for surgery, counseling on safety and for women of childbearing age, bone health, behavioral health and SUDEP awareness. The encounters were categorized into 2 groups: epileptologist vs. other neurologists. For group comparisons, we used two sample t-tests for age and epilepsy duration and chi-square tests for the categorical and binary variables. P-values <0.05 were significant. We used SAS version 9.2 for analyses.Results: We included 207 patient encounters; 92 by epileptologists and 115 by other neurologists. Significant differences for age (neurologists treated on average older patients), marital status (neurologists treated more married patients), duration of epilepsy (epileptologists provided care to patients with longer duration of epilepsy) and intractable epilepsy (epileptologists treated higher percentage of patients with intractable epilepsy) were noted between the two groups. Very few encounters (2%, n=5) had complete documentation of all 8 AAN epilepsy measures. Overall seizure frequency (97%) and type (80%) were the most likely to be documented. The least likely to be documented were counseling for safety (23%) and women of childbearing potential (11%). Statistically significant differences were observed between the epileptologists and other neurologists for seizure type (89% vs. 72%), epilepsy syndrome (85% vs. 62%) and drug side effects (65% vs 48%). For all of these measures, epileptologists had higher rates of documentation compared to other neurologists. There was also a statistically significant difference between the two groups for behavioral health with epileptologists more likely to document information (36% vs. 20%). No encounters had documentation for SUDEP.Conclusions: We identified differences in practicing patterns between epileptologists and other neurologists in relation to documentation of seizure type, epilepsy syndrome and AEDs side effects. Very few providers documented all 8 measures. Epileptologists had overall higher rate of documentation of quality measures. Despite behavioral health being addressed by epileptologists, the frequency of documentation was low. By developing strategies to reinforce integration of the epilepsy quality measures into daily practice, we can significantly improve epilepsy care.