Abstracts

Rationale: Assessment of quality of care is sparse,(1) despite development of American Academy of Neurology quality indicators (AAN-QI) and even more rarely reflects patients' perception of care,(2) or connects quality of care to patient outcomes. We assessed the association of quality of epilepsy care and outcomes meaningful to patients. Methods: We mailed invitation letters to a stratified random sample of Veterans with epilepsy who received VA care in 2015, oversampling women and those < 65 years, recontacting non-responders 3 and 6 weeks after initial mailing (35% response). The letters included a link to the electronic survey and a paper survey, requesting completion of 4 measures: 1) AAN-QI adherence: patient reported receipt of care including items used previously(2) and new items based on 2014 AAN-QI.(3) These items included clinician inquiry about number of seizures, side-effects of medications, symptoms of depression, and counseling provided on epilepsy/safety. We created a count of the number of indicators evaluated(range 0-4). 2) Satisfaction with epilepsy care (0 to 5) 3) The Personal Impact of Epilepsy Scale (PIES; Seizure, Medication, Comorbidity scales [Range 0-100 each]) 4) A newly developed short form of epilepsy self-efficacy (SF-ESE; factor score) Frequencies of AAN QI adherence and differences in patient satisfaction, PIES scores, and SF-ESE by AAN QI adherence level were assessed using analysis of variance. Results: Of the 319 individuals who completed the survey, AAN-QI adherence was 15% for all four measures, 11% for 3, 9% for 2, 12% for 1 and 10% for 0. Satisfaction varied significantly by AAN-QI adherence (F(4, 302) = 6.77, p < 0.01). There were no statistically significant differences on PIES subscales by AAN-QI adherence levels. Mean SF-ESE scores were significantly different by AAN-QI adherence levels (F(4, 152) = 4.02, p < 0.01); scores were significantly higher for those with 3 and 4 QI than 0 or 1 QI reported. Conclusions: AAN QI adherence was similar to prior studies conducted using chart abstraction and patient self-report. (1, 2) Significant relationships between AAN QI adherence and satisfaction/SF-ESE may be associated with the perception of more care being given or the quality of care; however, causation cannot be inferred with our cross sectional design. The lack of association between the PIES-an epilepsy severity suggests that the QI indicators of clinical care is not reflected in patient perception of their health (epilepsy) status. Additional research is needed to better understand the temporal relationship between quality of care and patient reported outcomes. Funding: Funding: I01HX000717-01, VA Health Services Research and Development Service References: 1. Pourdeyhimi R, Wolf BJ, Simpson AN, Martz GU. Adherence to outpatient epilepsy quality indicators at a tertiary epilepsy center. Epilepsy Behav 2014;39:26-32 2. Wicks P and Fountain NB. Patient assessment of physician performance of epilepsy quality-of-care measures. Neurol Clin Pract 2012;2(4):335-342. 3. Fountain NB, et al. (2015). Quality improvement in neurology: Epilepsy Update Quality Measurement Set. Neurology 84(14):1483-1487.