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Published online before print October 10, 2007, doi:10.1212/01.WNL.0000291947.29643.9f)
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NEUROLOGY 2007;69:2020-2027
© 2007 American Academy of Neurology
Contemporary Issues

What constitutes high quality of care for adults with epilepsy?

M.J.V. Pugh, PhD, RN, D. R. Berlowitz, MD, MPH, G. Montouris, MD, B. Bokhour, PhD, J. A. Cramer, BS, V. Bohm, MPH, M. Bollinger, MPH, S. Helmers, MD, A. Ettinger, MD, K. J. Meador, MD, N. Fountain, MD, J. Boggs, MD, W. O. Tatum, IV, DO, J. Knoefel, MD, MPH, C. Harden, MD, R. H. Mattson, MD and L. Kazis, ScD

From the Department of Veterans Affairs (M.J.V.P., M.B.), South Texas Veterans Health Care System VERDICT HSR&D, San Antonio; University of Texas Health Science Center at San Antonio (M.J.V.P., M.B.), Department of Internal Medicine; Center for Health Quality, Outcomes and Economic Research (D.R.B., B.B.), Bedford VA Hospital, MA; Boston University School of Medicine (G.M.), Department of Neurology, MA; Yale University (J.A.C.), Department of Psychiatry, West Haven, CT; Center for the Assessment of Pharmaceutical Practices (CAPP) (B.B., V.B., L.K.), Department of Health Policy and Management, Boston University School of Public Health, MA; Emory University School of Medicine (S.H.), Atlanta, GA; Long Island Jewish Medical Center (A.E.), Department of Neurology, New Hyde Park, NY; University of Florida School of Medicine (K.J.M.), Department of Neurology, Gainesville; University of Virginia School of Medicine (N.F.), Department of Neurology, Charlottesville; Orlando Regional Healthcare (J.B.), FL; Tampa General Healthcare Outpatient Epilepsy Clinic (W.O.T.), University of South Florida; The University of New Mexico School of Medicine (J.K.), Veterans Administration Hospital, Albuquerque; Weill Medical College of Cornell University (C.H.), New York Hospital, Comprehensive Epilepsy Center, New York; and Yale University School of Medicine (R.H.M.), New Haven, CT.

Address correspondence and reprint requests to Dr. Mary Jo Pugh, South Texas Veterans Health Care System (VERDICT), Audie L. Murphy Division (11C6), 7400 Merton Minter Boulevard, San Antonio, TX 78229-4404 PughM{at}uthscsa.edu

Background: Providers are increasingly being held accountable for the quality of care provided. While quality indicators have been used to benchmark the quality of care for a number of other disease states, no such measures are available for evaluating the quality of care provided to adults with epilepsy. In order to assess and improve quality of care, it is critical to develop valid quality indicators. Our objective is to describe the development of quality indicators for evaluating care of adults with epilepsy. As most care is provided in primary and general neurology care, we focused our assessment of quality on care within primary care and general neurology clinics.

Methods: We reviewed existing national clinical guidelines and systematic reviews of the literature to develop an initial list of quality indicators; supplemented the list with indicators derived from patient focus groups; and convened a 10-member expert panel to rate the appropriateness, reliability, and necessity of each quality indicator.

Results: From the original 37 evidence-based and 10 patient-based quality indicators, the panel identified 24 evidence-based and 5 patient-based indicators as appropriate indicators of quality. Of these, the panel identified 9 that were not necessary for high quality care.

Conclusion: There is, at best, a poor understanding of the quality of care provided for adults with epilepsy. These indicators, developed based on published evidence, expert opinion, and patient perceptions, provide a basis to assess and improve the quality of care for this population.

Abbreviations: AED = antiepileptic drug; AHRQ = Agency for Health Research and Quality; NICE = National Institute for Health and Clinical Excellence; QUIET = Quality Indicators for Epilepsy Treatment; SIGN = Scottish Intercollegiate Guidelines Network.

Supplemental data at www.neurology.org

Editorial, page 1968

e-Pub ahead of print on October 10, 2007, at www.neurology.org.

Funded by the Centers for Disease Control to Dr. Kazis, Principal Investigator (Project Number S3492-23/23).

Disclosure: Mary Jo V. Pugh, PhD, RN = research grant from Abbott; Joyce A. Cramer, BS = Consultant for Abbott, Eisai, GlaxoSmithKline, Johnson & Johnson, Pfizer, Schwarz, UCB; Sandra Helmers, MD = speaker bureau for Abbott, Cyberonics, Novartis, Glaxo Smith Klein, UCB Pharma; Consultant for Glaxo Smith Klein, UCB Pharma, Abbott; Alan Ettinger, MD = member of the advisory board for Glaxo Smith Kline and Cyberonics; lectured for Eisai, Glaxo Smith Kline, Cyberonics, and UCB Pharma. Grant support: Glaxo Smith Kline, Eisai, and Cyberonics. No receipts from any individual company exceed $10,000. Kimford Meador, MD = research grant support from GlaxoSmithKline, Eisai, Myriad, Neuropace, SAM Technology, UCB, and the National Institutes of Health. Jane Boggs, MD = speaker bureau for Abbott, Glaxo Smith Klein, Ortho McNeil, Eisai, UCB Pharma, Novartis, Xcel, and Cyberonics; research support from Abbott. Cynthia Harden, MD = speaker for Glaxo Smith Klein, Novartis, and UCB Pharma; consultant for Glaxo Smith Klein and Cyberonics; and research support from UCB Pharma, Ortho McNeil, and the NIH. Richard H. Mattson, MD = an advisor and speaker for Abbott, Novartis, Ortho, Pfizer, and UCB Pharma; Dr. Mattson has no employee status or stock ownership for any of the aforementioned companies.

Received December 4, 2006. Accepted in final form February 28, 2007.




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