Measuring migraine-related quality of care across 10 health plans

To refine a previously published standardized quality and utilization measurement set for migraine care and to establish performance benchmarks.

Retrospective application of the migraine measurement set to health plan data in order to assess patterns of health service utilization.

Measurement specifications were applied to data from 10 health plans for measurement year 2009.

Of the 2.9 million continuously enrolled members of the health plans, 138,004 (4.7%) met inclusion criteria for the migraine population. Of these, 26% did not have a migraine diagnosis, but were utilizing migraine drugs; 12% had a computed tomography scan within the year (range 8%-25% across plans); and 8% had magnetic resonance imaging (range 6%-11%). Nearly 18% of the migraineurs had 1 or more visits to an emergency department/urgent care center for migraine; few (6%) were followed up with primary care visits. Approximately one-fourth of the migraineurs were not being routinely monitored by a physician. Medication utilization also was examined for members of the migraine population with pharmacy benefits. A significant proportion (42%) were given a migraine preventive, 38% had at least 1 prescription for a triptan, and 2% of those on triptans were potentially overutilizing the medication. Among patients aged 18 to 49 years who were given triptans, 3% had a cardiac contraindication; this percentage rose to 7% for patients aged 50 to 64 years.

This study demonstrates the value of standardized measures in identifying potential quality issues for migraine care, including underdiagnosis, overutilization of imaging, and underutilization of preventive drugs.