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Published on: June 2, 2014
Patient headache questionnaires can improve headache diagnosis and treatment in children
Christina L Szperka1,2, Stephanie Witzman2, Svetlana Ostapenko2
1Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
An electronic health record (EHR)-integrated headache questionnaire improved migraine diagnosis specificity and treatment prescription rates in pediatric neurology patients. This tool enhances diagnostic accuracy and patient care for headache and migraine conditions.
Area of Science:
- Pediatric Neurology
- Clinical Informatics
- Headache Medicine
Background:
- Under-diagnosis of migraine in pediatric populations contributes to disease burden.
- A recognized need existed to improve migraine diagnosis rates within a pediatric headache program.
- Initial observations indicated a lower-than-expected proportion of migraine diagnoses among headache patients.
Purpose of the Study:
- To analyze trends in headache and migraine diagnoses in a large pediatric neurology cohort.
- To evaluate the effectiveness of an electronic health record (EHR)-integrated headache questionnaire in increasing diagnostic specificity.
- To determine if the questionnaire improves the likelihood of prescribing appropriate migraine treatment.
Main Methods:
- Development and implementation of a headache questionnaire, transitioning from paper to EHR integration.
- Comparison of diagnostic trends (specific vs. non-specific diagnoses) before and after questionnaire implementation.
- Prospective cohort study to assess the association between questionnaire use, diagnostic specificity, and migraine treatment prescription.
Main Results:
- The proportion of migraine diagnoses increased by 9.7%, while non-specific headache diagnoses decreased by 21.0% over the study period.
- EHR questionnaire use significantly increased specific diagnosis rates (87.2% vs. 75.5%), nearly doubling diagnostic odds (OR 1.90).
- Specific diagnoses more than doubled the odds of migraine treatment prescription (OR 2.39) compared to non-specific diagnoses.
Conclusions:
- Interventions improving diagnostic specificity were effective in increasing migraine treatment rates.
- The positive impact on diagnosis and treatment has been sustained over several years.
- The EHR-integrated questionnaire is a valuable, broadly available tool for clinical and research purposes in institutions using EpicCare.
Objective:
To examine trends in diagnosis of headache and migraine in a large pediatric neurology cohort, and test whether an electronic health record (EHR)-integrated headache questionnaire can increase specificity of diagnosis and likelihood of prescribing migraine treatment.
Background:
Under-diagnosis of migraine contributes to the burden of disease. As we founded our Pediatric Headache Program in 2013, we recognized that the proportion of patients with headache who were given a diagnosis of migraine was much lower than expected.
Methods:
We developed a patient headache questionnaire, initially on paper (2013-2014), then in an electronic database (2014-2016), and finally integrated into our electronic health record (pilot: 2016, full: May 2017). We compared diagnoses and prescribed treatments for new patients who were given a headache diagnosis, looking at trends in the proportion of patients given specific diagnoses (migraine, etc.) versus the non-specific diagnosis, "headache." Next, we conducted a prospective cohort study to test for association between provider use of the form and the presence of a specific diagnosis, then for an association between specific diagnosis and prescription of migraine treatment.
Results:
Between July 2011 and December 2022 the proportion of new headache patients who were given a diagnosis of migraine increased 9.7% and non-specific headache diagnoses decreased 21.0%. In the EHR cohort (June 2017-December 2022, n = 15,122), use of the provider form increased the rate of specific diagnosis to 87.2% (1839/2109) compared to 75.5% (5708/7560) without a patient questionnaire, nearly doubling the odds of making a specific diagnosis (odds ratio [OR] 1.90, 95% confidence interval [CI]: 1.65-2.19). Compared to those given only a non-specific headache diagnosis who were prescribed a migraine therapy 53.7% (1766/3286) of the time, 75.3% (8914/11836) of those given a specific diagnosis received a migraine therapy, more than doubling the odds of prescription (OR 2.39, 95% CI: 2.20-2.60).
Conclusions:
Interventions to improve specificity of diagnosis were effective and led to increased rates of prescription of migraine treatments. These results have been sustained over several years. This headache questionnaire was adapted into the Foundation system of EpicCare, so it is broadly available as a clinical and research tool for institutions that use this EHR software.
