Abstracts

Rationale: The American Academy of Neurology (AAN) Subcommittee on Quality Measurement and Reporting is in the process of establishing practice requirements for neurologists specializing in the care of epilepsy patients. Proposed requirements include documentation of 1) seizure type, 2) frequency, 3) etiology/syndrome, 4) EEG results, 5) neuroimaging findings, 6) antiepileptic drugs (AEDs), 7) drug side effects, 8) candidacy for surgery, 9) safety/driving issues, and 10) women s issues (including contraception, vitamin supplementation, and bone health) for every new epilepsy patient evaluated. These requirements may have implications on maintenance of certification. The purpose of this quality improvement study is to establish an effective method of documenting the essential elements in the evaluation of new epilepsy patients. Methods: A one-page questionnaire was developed to incorporate the above 10 elements and given to new patients evaluated in the Mayo Clinic Arizona Epilepsy Clinic for a one month period of time, May 2010. A retrospective control group was established, including all new patient evaluations conducted in May 2009, for comparison. Epilepsy and indeterminate spells were included in the analysis while patients with syncope or other imitators of epilepsy were excluded. Each encounter was reviewed and scored on a 10-point scale, with one point given for the documentation of each item in the proposed requirements listed above. The two groups were analyzed. Results: Analysis of the retrospective control group demonstrated an average score of 7.0 out of 10 for each chart reviewed. The most frequently documented items included seizure frequency (90.5%), previous EEG results (95.2%), and antiepileptic medication use (90.5%). The least documented items included candidacy for surgery (33.3%) and safety issues (38.1%). Although women s issues appeared to be adequately documented (71.4%), it should be noted that documentation was considered adequate either if the patient was male, or if only one of the subtopics were covered. Documentation from the prospective questionnaire group was adequate for all charts, since when instructed, patients were faithful in completing the questionnaire. Conclusions: The AAN is developing methods to improve practice standards across all specialties, including epilepsy. Standardizing practice will lead to improved quality in patient care and subsequently translate into better outcomes for patients. In this single-center study, the retrospective data suggests that there is opportunity for improvement in discussing and documenting several key elements including: patient safety issues (including driving), women s issues, and documenting the patient s candidacy for epilepsy surgery. Novel techniques can be implemented to improve the discussion and documentation of these important patient discussions into clinical practice. This study demonstrates that a simple questionnaire is effective in increasing compliance towards the AAN epilepsy requirements, in turn improving the care of people with epilepsy.