A Multicenter Study of Adherence to Best Practices and Application of Epilepsy Quality Metrics in a Pediatric
Charuta N Joshi1, Joseph S Miller2, Lori J Silveira1
1Children's Hospital Colorado, Anschutz Medical Campus, 2932University of Colorado, Denver, CO, USA.
Insights
Pediatric epilepsy quality metrics and guideline implementation in telemedicine visits show room for improvement. Key areas like seizure safety and medication review need more attention for better patient outcomes.
Area of Science:
- Neurology
- Telemedicine
- Quality Improvement
Background:
- Telemedicine has expanded pediatric epilepsy care.
- Assessing adherence to quality metrics and guidelines is crucial for effective care delivery.
- Pediatric epilepsy quality metrics (EQM) provide a framework for evaluating care.
Purpose of the Study:
- To evaluate the implementation of Epilepsy Quality Metrics (EQM) and clinical guidelines in new pediatric epilepsy patients receiving telemedicine care.
- Identify areas of strength and weakness in current telemedicine practices for pediatric epilepsy.
Main Methods:
- Multicenter, cross-sectional, retrospective analysis of electronic health records.
- Inclusion of 160 pediatric epilepsy patients within the EQM cohort.
- Data collection on documented clinical encounters, including seizure characteristics, management, and anticipatory guidance.
Main Results:
- High documentation rates for seizure description (95%) and diagnosis (77%).
- Lower rates for quality of life discussions (3%) and specific anticipatory guidance (e.g., SUDEP 11%, pregnancy 10%).
- Epileptologists were more likely to discuss driving safety compared to generalists (OR 3.93).
Conclusions:
- Current performance on EQM and guideline implementation in pediatric epilepsy telemedicine can be enhanced.
- Targeted interventions are needed to improve discussions on quality of life and comprehensive anticipatory guidance.
- Specialist involvement may improve adherence to certain quality metrics, like driving safety discussions.
Abstract:
Objective: To assess Epilepsy Quality Metrics (EQM) and guideline implementation in new pediatric patients seen in telemedicine. Methods: Multicenter, cross sectional, retrospective analysis. Results: Patients were similar across 3 centers for age, gender, and insurance type. Eighty-one percent presented for spells. One hundred sixty patients with epilepsy formed the EQM cohort. Results: Seizures described: 95%; frequency: 67%, last seizure documented: 81%, epilepsy syndrome documented: 67%; epilepsy diagnosis: 77%, medications reviewed: 56%, adverse events discussed: 73%. Quality of life discussed: 3%. Anticipatory guidance was described as follows: seizure safety, 57%; driving, 47%; SUDEP, 11%; vitamin D discussion, 19%; pregnancy and folic acid counseling, 4% and 10%. Epileptologists were 4 times as likely as generalists in discussing driving safety (odds ratio 3.93, 95% confidence interval 1.7-8.9; P = .001) for all ages. Significance: Performance on EQM and guideline implementation in pediatric epilepsy telemedicine encounters can be improved.
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