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Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy
Published on: April 11, 2019
Implementation of quality measures and patient-reported outcomes in an epilepsy clinic
Lidia M V R Moura1, Brandon Magliocco2, John P Ney2
1From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA. lidia.moura@mgh.harvard.edu.
Objective:
To see if systematic collection of patient-reported epilepsy quality measures can identify opportunities to improve care, and to examine the associations between these measures and physical and mental health.
Methods:
We developed a patient-reported questionnaire for medication adherence, seizure frequency, medication side effects, and driving that included the Patient-Reported Outcome Measurement Information System-10 (PROMIS-10) (physical and mental health). We offered it to all adult patients seen twice in an epilepsy clinic (January 2017-January 2018). The questionnaire was available on the web as well as a tablet provided at appointment check-in. We used the first completed questionnaire to explore the relationship between patient-reported care quality and measures of physical and mental health.
Results:
A total of 610 unique patients (15% of the total encounters) completed a survey. Respondents were comparable to nonrespondents. Respondents reported gaps in care or opportunities for quality improvement in 48.4% (n = 295) of the encounters. Of patients who reported at least 1 seizure per month over the previous 3 months, 55.2% (n = 100) reported problems with adherence, 30.0% (n = 131) reported having problems believed to be adverse reactions to anticonvulsants, and 15.2% (n = 41) reported driving. In addition, respondents who reported either seizures over the recent 3 months, nonadherence to treatment due to cost, or anticonvulsant-associated adverse effects had consistently worse physical and mental health (all p < 0.05).
Conclusions:
Systematic collection of epilepsy quality measures endorsed by the American Academy of Neurology can identify opportunities for quality improvement. Measures of epilepsy care quality predict outcomes that matter to patients.
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