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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.
* To whom correspondence should be addressed. E-mail: 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.
This article has been cited by other articles:
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  B. G. Bokhour, M. J. Pugh, J. K. Rao, R. Avetisyan, D. R. Berlowitz, and L. E. Kazis Improving Methods for Measuring Quality of Care: A Patient-Centered Approach in Chronic Disease Med Care Res Rev, April 1, 2009; 66(2): 147 - 166. [Abstract] [PDF]
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 J. T. Langfitt Do we know quality epilepsy care when we see it? Neurology, November 20, 2007; 69(21): 1968 - 1969. [Full Text] [PDF]
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