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Abstract

Background

Quality measures (QMs) exist to operationalize guidelines by measuring adherence to guidelines through documentation, ultimately leading to improved patient outcomes. Studies are rare looking at the relationship between adherence to Parkinson disease (PD) QMs and patient outcomes.

Methods

We assessed adherence of our movement disorders specialists (MDSs) to the American Academy of Neurology's 2010 PD QM set through chart review using the measure set work group's criteria of documentation. We then evaluated patient outcomes to see whether there was a correlation with adherence to these QMs.

Results

Ninety-seven consecutive patients met the inclusion criteria. The mean disease duration was 9.3 (5.8) years. All patients were assessed by 1 of 4 MDSs. A total of 68% of QMs were documented across all patients. There was a small positive correlation between the number of documented QMs the year before the index visit and the number of calls/emails both the year before and after the index visit (r = 0.20, p = 0.04 and r = 0.26, p = 0.01, respectively.) There was a small negative correlation between the number of documented QMs and the number of PD follow-up visits the year after the index visit (r = −0.19, p = 0.05.) No other outcome showed a statistically significant correlation with the adherence to documented QMs.

Conclusions

We found no clinically important improvement in patient outcomes with higher adherence levels. It is important that QM developers validate QMs to ensure that they fulfill the intended goal of improved patient outcomes.

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Information & Authors

Information

Published In

Neurology® Clinical Practice
Volume 10Number 1February 2020
Pages: 58-64
PubMed: 32190421

Publication History

Received: May 19, 2019
Accepted: August 15, 2019
Published online: October 7, 2019
Published in print: February 2020

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Disclosure

J.P. Martello receives compensation for speaking for Lundbeck, AbbVie, Teva, and Acorda and serving on advisory boards for Lundbeck and AbbVie. L.M. Shulman receives research support from the NIH (1R01AG059651-01 and 1R21AG058118-01), Claude D. Pepper Older Americans Independence Center (3P30AG028747-13S30), University of Maryland Center for Health-Related Informatics and Bioimaging, Pfizer Pharmaceuticals (investigator-initiated study), Eugenia and Michael Brin, and The Rosalyn Newman Foundation. She receives royalties from Johns Hopkins University Press and Oxford University Press. E. Barr reports no disclosures. A. Gruber-Baldini receives research support from the NIH (R R01 AG059651; R21AG054143) and Gilead Science, Inc. M.J. Armstrong receives compensation from the AAN for work as an evidence-based medicine methodology consultant and serves on the level of evidence editorial board for Neurology and related publications (uncompensated). She receives research support from Agency for Healthcare Research & Quality (K08HS24159), a 1Florida ADRC (AG047266) pilot grant, and as the local PI of a Lewy Body Dementia Association Research Center of Excellence. She receives royalties from the publication of the book Parkinson's Disease: Improving Patient Care, and she has received honoraria for presenting at the AAN annual meeting (2017) and participating in Medscape CME. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
Take-home Points
→ There were no clinically meaningful effects to patient outcomes based on PD QM documentation/adherence.
→ Adherence overall to the PD QM set for our movement disorder specialists was 68%.
→ There is room for improvement in the development of QMs and testing their validity on patient outcomes before they are widely adopted.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Justin Martello, MD
Department of Neurosciences (JM), Christiana Care Health System, Newark, DE; Department of Neurology (LMS), University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health (EB, AGB), University of Maryland School of Medicine, Baltimore, MD; and Department of Neurology (MJA), University of Florida College of Medicine, Gainesville, FL.
Disclosure
Scientific Advisory Boards:
1.
(1) Abbvie (2) Lundbeck
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) Teva, speaker honoraria, (2) Abbvie, speaker honoraria, (3) Lundbeck, speaker honoraria, (4) Acorda, speaker honoraria
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Department of Neurosciences (JM), Christiana Care Health System, Newark, DE; Department of Neurology (LMS), University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health (EB, AGB), University of Maryland School of Medicine, Baltimore, MD; and Department of Neurology (MJA), University of Florida College of Medicine, Gainesville, FL.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
AAN Brain&Life Patient Book Series, Editor-in-Chief, 2007-2018; Brain&Life Magazine, Advisory Board member, 2007-2018
Patents:
1.
NONE
Publishing Royalties:
1.
Parkinson's Disease: A Complete Guide for Patients and Families, Johns Hopkins University Press, 2000, 2007, 2013; Before and After Loss: A Neurologist's Perspective on Loss, Grief and Our Brain, Johns Hopkins University Press, 2018.
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH Grant 1R01AG059651-01 (Multi PI), 2018-2023
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
1) Michael J. Fox Foundation for Parkinsons Research, 2) The Rosalyn Newman Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Department of Neurosciences (JM), Christiana Care Health System, Newark, DE; Department of Neurology (LMS), University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health (EB, AGB), University of Maryland School of Medicine, Baltimore, MD; and Department of Neurology (MJA), University of Florida College of Medicine, Gainesville, FL.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Department of Neurosciences (JM), Christiana Care Health System, Newark, DE; Department of Neurology (LMS), University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health (EB, AGB), University of Maryland School of Medicine, Baltimore, MD; and Department of Neurology (MJA), University of Florida College of Medicine, Gainesville, FL.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
National Institutes of Health: Principal Investigator (MPI with Lisa Shulman) “PROMIS Profile Measures in Older Adults – Identifying Cognitive Thresholds for Reliable and Valid Responses” R01 AG059651-01; Project dates: 9/1/18-5/31/23
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Melissa J. Armstrong, MD, MSc
Department of Neurosciences (JM), Christiana Care Health System, Newark, DE; Department of Neurology (LMS), University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health (EB, AGB), University of Maryland School of Medicine, Baltimore, MD; and Department of Neurology (MJA), University of Florida College of Medicine, Gainesville, FL.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) American Academy of Neurology, travel to guideline subcommittee meetings (2) Lewy Body Dementia Association, travel to Lewy Body Dementia Association Research Center of Excellence investigator meetings
Editorial Boards:
1.
(1) Neurology, Level of Evidence Editorial Board, 2012- current
Patents:
1.
NONE
Publishing Royalties:
1.
(1) Parkinson's Disease: Improving Patient Care, Oxford University Press, 2014
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
(1) American Academy of Neurology Evidence-Based Medicine Methodology Consultant
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
(1) Medscape CME, speaking and writing honoraria
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) NIH, 1U01AR057967, local sub-investigator, 2013-2015 (2) ARHQ, K08HS024159, PI, 2015-2020 (3) 1Florida ADRC (AG047266) pilot grant, PI, 2018
Research Support, Academic Entities:
1.
(1) Huntington Study Group (2014-2015) (2) TBI Endpoints Development Initiative (2016-2017) (3) Michael J. Fox Foundation (2016-2018)
Research Support, Foundations and Societies:
1.
(1) Lewy Body Dementia Association Research Center of Excellence
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Martello [email protected]
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

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