TY - JOUR
T1 - Association of adherence to epilepsy quality standards with seizure control
AU - Moura, Lidia M.V.R.
AU - Mendez, Diego Yacaman
AU - Jesus, Jonathan De
AU - Andrade, Rogger A.
AU - Weissman, Joel S.
AU - Vickrey, Barbara G.
AU - Hoch, Daniel B.
N1 - Funding Information:
This study is supported by Eisai, Inc through a 2014 Epilepsy Foundation Research Training Fellowship for Clinicians.
Funding Information:
Barbara G. Vickrey receives support from NIH/NINDS 1U54NS081764 and R37NS031146 , Genentech , UniHealth Foundation , and California Community Foundation .
Funding Information:
Lidia M.V.R. Moura received an Epilepsy Foundation Research Training Fellowship supported by Eisai, Inc, and an American Academy of Neurology Clinical Research Training Fellowship supported by the American Brain Foundation.
Publisher Copyright:
© 2015 Elsevier B.V.
PY - 2015/11
Y1 - 2015/11
N2 - Objective: We assessed the relationship between adherence to epilepsy quality measures (EQM) and seizure control over 2-3 years in a retrospective cohort study. Methods: 6150 patients were identified at two large academic medical centers with a primary or secondary diagnosis of epilepsy, were 18-85 years old and seen in outpatient general neurology or epilepsy units between June 2011 and May 2014. Patients were included if: their initial visit was between June 2011 and June 2012, treatment was with ≥1 anti-seizure drug, there was ≥1 visit per year during the timeframe, and seizure frequency was documented at initial and final visits, yielding 162 patients/1055 visits from which socio-demographic, clinical and care quality data were abstracted. Quality care was assessed as (1) percent adherence to up to 8 eligible EQM, and (2) defect-free care (DFC: adherence to all eligible EQM). Seizure control (SC) was defined as ≥50% reduction in average seizures/month between initial and final visits. Chi-square and t-test compared care quality with seizure control. Logistic regression was used to assess the relationships between SC, quality of care and subspecialist involvement. Results: Care quality, reflected by documentation of seizure frequency, addressing therapeutic interventions, and referral to a comprehensive epilepsy center, all exceeded 80% adherence. Care quality as reflected by documentation of seizure type, etiology or syndrome; assessment of side effects, counseling about epilepsy safety and women's issues, and screening for psychiatric disorders ranged from 40 to 57%. Mean EQM adherence across all applicable measures was associated with greater seizure control (p= 0.0098). DFC was low (=8%) and did not covary with seizure control (p= 0.55). The SC and non-SC groups only differed on epilepsy etiology (p= 0.04). Exploratory analysis showed that mean quality scores are associated with seizure control (OR. = 4.9 [1.3-18.5], p=0.017) while controlling for the effect of subspecialty involvement as a possible confounding variable. Conclusions: Average quality of care but not defect-free care was associated with seizure control in this retrospective cohort.
AB - Objective: We assessed the relationship between adherence to epilepsy quality measures (EQM) and seizure control over 2-3 years in a retrospective cohort study. Methods: 6150 patients were identified at two large academic medical centers with a primary or secondary diagnosis of epilepsy, were 18-85 years old and seen in outpatient general neurology or epilepsy units between June 2011 and May 2014. Patients were included if: their initial visit was between June 2011 and June 2012, treatment was with ≥1 anti-seizure drug, there was ≥1 visit per year during the timeframe, and seizure frequency was documented at initial and final visits, yielding 162 patients/1055 visits from which socio-demographic, clinical and care quality data were abstracted. Quality care was assessed as (1) percent adherence to up to 8 eligible EQM, and (2) defect-free care (DFC: adherence to all eligible EQM). Seizure control (SC) was defined as ≥50% reduction in average seizures/month between initial and final visits. Chi-square and t-test compared care quality with seizure control. Logistic regression was used to assess the relationships between SC, quality of care and subspecialist involvement. Results: Care quality, reflected by documentation of seizure frequency, addressing therapeutic interventions, and referral to a comprehensive epilepsy center, all exceeded 80% adherence. Care quality as reflected by documentation of seizure type, etiology or syndrome; assessment of side effects, counseling about epilepsy safety and women's issues, and screening for psychiatric disorders ranged from 40 to 57%. Mean EQM adherence across all applicable measures was associated with greater seizure control (p= 0.0098). DFC was low (=8%) and did not covary with seizure control (p= 0.55). The SC and non-SC groups only differed on epilepsy etiology (p= 0.04). Exploratory analysis showed that mean quality scores are associated with seizure control (OR. = 4.9 [1.3-18.5], p=0.017) while controlling for the effect of subspecialty involvement as a possible confounding variable. Conclusions: Average quality of care but not defect-free care was associated with seizure control in this retrospective cohort.
KW - Epilepsy care
KW - Epilepsy quality measures
KW - Seizure control
UR - http://www.scopus.com/inward/record.url?scp=84946238246&partnerID=8YFLogxK
U2 - 10.1016/j.eplepsyres.2015.08.008
DO - 10.1016/j.eplepsyres.2015.08.008
M3 - Article
C2 - 26370916
AN - SCOPUS:84946238246
SN - 0920-1211
VL - 117
SP - 35
EP - 41
JO - Epilepsy Research
JF - Epilepsy Research
ER -