Abstracts

Rationale: Due to gaps in practice and recommended guidelines, there has been a recent push toward implementing quality measures to be used for improving patient care. Quality measures for the care of epilepsy were developed and published in January 2011. The purpose of this pilot study was to evaluate and assess the implementation of the epilepsy quality measures in our department.Methods: The eight quality measures assessed were: seizure type and current seizure frequency, documentation of etiology of epilepsy or epilepsy syndrome, EEG results, MRI/CT scan, querying and counseling about antiepileptic drug side effects, surgical therapy referral consideration for intractable epilepsy, counseling about epilepsy specific safety issues, and counseling for women of childbearing potential with epilepsy. Clinic charts of established patients with a diagnosis of epilepsy were reviewed over a week period in April 2011. Sixty established patients carrying a diagnosis of epilepsy were identified. Twenty five were seen in the pediatric neurology clinic and 35 were evaluated in the adult neurology clinic. There were 32 women (17 of childbearing age) and 28 men. The mean age was 9.8 years old for the pediatric patients and 35.2 years old for the adult patients. Results: The most frequently documented epilepsy measures included EEG and brain imaging that were reviewed or requested for all patients except for 1 pediatric patient who did not have an EEG since he was placed in hospice care (98.3% compliance). The seizure type and frequency were addressed for all patients except for 1 adult patient for whom the seizure frequency was not addressed and for 1 pediatric patient for whom the seizure type that was not addressed (96.6% compliance). Seizure etiology was addressed for all patients except for 3 pediatric patients and 1 adult (93.3% compliance). Candidacy for surgery was not addressed in 6 patients, 5 pediatric patients and 1 adult (90% compliance). Counseling of women of childbearing age was performed in all but 4 patients (93.3% compliance). The least addressed measures included antiepileptic medication side effects which were not queried in 9 patients during their visit, 5 pediatric patients and 4 adults (85% compliance). Safety issues were not discussed with 27 patients during their visit, 22 pediatric patients and 5 adults (55% compliance). Conclusions: In this pilot study looking at the implementation of the epilepsy measures in a single institution, the least documented epilepsy quality measures included counseling on safety and query about antiepileptic medication side effects. The use of a standardized electronic template or note and practitioner education may help in assuring 100% compliance with the epilepsy measures. It would helpful to develop a system of tracking and further evaluate the implementation of the epilepsy measures on a long term base and over a more prolonged period of time.