The AAN has launched efforts to develop key measures for the care of several neurologic conditions. A stroke measure was completed more than two years ago, and two new measure sets have now been developed and approved by the AAN. The Parkinson disease measure set appeared in the Nov. 30 edition of Neurology (See the Dec. 2 Neurology Today story, “Measure for Measure: AAN Develops Measures for Parkinson Disease,” www.neurotodayonline.com) and on Jan. 4, the measure set for epilepsy was published in Neurology.
The eight epilepsy measures focus on specific activities that should take place at initial or follow-up visits for patients with defined ICD-9 diagnoses of epilepsy. For example, at an initial visit, the measures call for the neurologist to determine the frequency of each seizure type, state the etiology or epilepsy syndrome involved, and review with the patient anti-epileptic drug side effects.
The side effect review is considered a safety measure and was reviewed by the National Quality Forum, the national organization that endorses measures for possible adoption by the Centers for Medicare & Medicaid, said Nathan Fountain, MD, professor of neurology and director of the F.E. Dreifuss Comprehensive Epilepsy Program at the University of Virginia School of Medicine, who was the lead author of the epilepsy measure.
There will be an epilepsy-related maintenance of certification module available next year, said. Dr. Fountain. “This will allow physicians to measure their performance, learn from their results and then measure their performance again to see if they've improved. That module could potentially incorporate all the epilepsy-related measures we've put forward.”
For more information about the process of developing the performance measure sets, contact Rebecca Swain-Eng, AAN performance measurement program manager, at firstname.lastname@example.org. •
EPILEPSY MEASURES APPROVED BY THE AAN:
* Seizure type and current seizure frequency: All visits with the type(s) of seizures(s) and current seizure frequency for each seizure type documented in the medical record.
* Documentation of etiology of epilepsy or epilepsy syndrome: All visits with the etiology of epilepsy or epilepsy syndrome reviewed and documented if known, or documented as unknown or cryptogenic.
* EEG results reviewed, requested, or test ordered: All initial evaluations with the results of at least one EEG reviewed or requested, or if EEG was not performed previously, then an EEG ordered.
* MRI/CT scan reviewed, requested, or scan ordered: All initial evaluations with the results of at least one MRI or CT scan reviewed or requested or, if a MRI or CT scan was not obtained previously, then a MRI or CT scan ordered (MRI preferred).
* Querying and counseling about antiepileptic drug side effects: All visits where patients were queried and counseled about antiepileptic drug side effects and the querying about counseling was documented in the patient record.
* Surgical therapy referral consideration for intractable epilepsy: All patients with a diagnosis of intractable epilepsy who were considered for referral for a neurologic evaluation of appropriateness for surgical therapy and the consideration was documented in the medical record with the past three years.
* Counseling about epilepsy specific safety issues: All patients who were counseled about context-specific safety issues, appropriate to the patient's age, seizure type(s) and frequency(ies), occupation and leisure activities, etc. (e.g., injury prevention, burns, appropriate driving restrictions, or bathing) at least once per year.
* Counseling for women of childbearing potential with epilepsy: All female patients of childbearing potential (12-44 years old) diagnosed with epilepsy who were counseled about epilepsy and how its treatment may affect contraception and pregnancy at least once per year.
Fountain NB, Van Ness PC, Bever CT Jr., et al, for the American Academy of Neurology Epilepsy Measure Development Panel and the American Medical Association-Convened Physician Consortium for Performance Improvement Independent Measure Development Process. Quality improvement in neurology: AAN epilepsy quality measures. Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Neurology 2011; 76:94–99.