Rationale:
Quality measures (QMs) are tools to help assess and improve patient care processes. Epilepsy-specific QMs generated by the American Academy of Neurology (AAN 2017 update) and the Pediatric Epilepsy Learning Healthcare System (PELHS) are based on current guidelines, evidence-based medicine, stakeholder opinions, and best practice consensus. Aiming to improve epilepsy care for the patient population served by our Child Neurology Division, we merged and optimized these QMs. QM adjustments based on local culture, provider preferences, and electronic medical record limitations are often required to optimize uptake. The overarching aims of our optimized QMs are i) improve patients’ seizure control by monitoring seizure type, frequency, and trend ii) improve patients’ quality of life by screening for mental health concerns, developmental milestones, school performance, behavioral concerns, sleep, transition to adult care, iii) improve patients’ safety by reducing status through seizure rescue plan, counseling on driving, contraception, and sudden unexplained death. Standardized epilepsy note templates are used to increase data collection and documentation, thereby increasing adherence to QMs.
Methods:
A list of criteria, based on our optimized QM aims, was developed to evaluate providers’ documentation adherence. We reviewed existing patient notes of non-standardized clinical data pertaining to patients with epilepsy. Three notes were randomly selected from each provider across varying roles. Providers were divided into two clinic groups: Pediatric Epilepsy and General Child Neurology. Applying a plan, do, study, act (PDSA) cycle, the first intervention involves a survey to both assess stakeholders’ (Child Neurology Division providers) buy-in, as well as educate providers about importance of addressing and documenting for our QM aims. Our second intervention is the creation of a shared note template with prompts guided by the QMs, thereby acting as a memory tool for providers. We are collecting clinic data following each intervention to assess for improvement.
Results:
Preliminary results demonstrate that the Epilepsy group had higher adherence to the QMs than the General Neurology group. There was variability within each group, with some providers consistently more adherent to specific measures than others. Some note templates used by certain epilepsy providers offered prompts consistent with many QMs. These providers were more likely to have higher adherence. There were limitations on assessing for adherence due to patient differences.
Conclusions:
We propose that the implementation of a note template will assist with adherence to epilepsy QMs. Based on our institutional practices, we can use the note template to emphasize certain aims that are critical for improved care, including rescue plans and counseling. Open-ended prompts without strict age guidelines would be helpful in our patient population, due to the high prevalence of developmental differences. With provider buy-in, this note template tool can be adapted into a data collection form to facilitate and standardize care of children with epilepsy at our institution.
Funding: No funding to report.