Department of Neurology, University of Virginia, Charlottesville, VA, USA.
Neurology. 2011 Jan 4;76(1):94-9. doi: 10.1212/WNL.0b013e318203e9d1.
Epilepsy is a common neurologic condition with significant personal, societal, medical, and economic burdens. There are considerable gaps in the quality of care delivered. Measuring the quality of care delivered is the first step to its improvement. Performance measures are easily identified and quantitated ways to assess whether specific activities were carried out during a patient encounter. Therefore, epilepsy performance measures were derived through a standardized systematic process and may be the basis for pay-for-performance initiatives and maintenance of certification requirements.
Epilepsy measures were developed through the American Medical Association-convened Physician Consortium for Performance Improvement (PCPI) independent measure development process, which marked the first time a medical specialty society followed this process. Guidelines, measures, and consensus papers reviewed for the period 1998 to 2008 using the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, PubMed, MEDLINE, and the Cochrane Library were evaluated using a framework to determine the acceptability of each guideline or other evidence review document for measures development. Recommendation statements based on level of evidence, importance, validity, and gap in care were developed into candidate measures. A panel of experts from representative organizations vetted the measures. A period of public comment was followed by approval from the American Academy of Neurology and the PCPI.
Literature search identified 160 relevant recommendation statements from 19 guidelines and 2 consensus papers. Systematic assessment resulted in 20 recommendation statements that were refined to 8 candidate measures by the expert panel. The measures are relevant to seizure type and frequency, etiology or epilepsy syndrome, EEG, neuroimaging, antiepileptic drug side effects, safety issues, referral for refractory epilepsy, and issues for women of childbearing potential.
There is a reasonable evidence base, and consensus for, deriving performance measures for quality of epilepsy care. It is anticipated that implementation of these performance measures will improve care for patients with epilepsy if adopted by providers.
癫痫是一种常见的神经系统疾病，给个人、社会、医疗和经济带来了重大负担。在提供的护理质量方面存在相当大的差距。衡量所提供的护理质量是改善护理质量的第一步。绩效指标是评估患者就诊期间是否开展了特定活动的简单明了且可量化的方法。因此，通过标准化系统流程得出了癫痫绩效指标，这些指标可能成为按绩效付费计划和维持认证要求的基础。
通过美国医学协会召集的医师绩效改进联盟（PCPI）独立措施制定流程制定了癫痫措施，这标志着医学专业学会首次采用该流程。使用国家指南清理中心、国家质量措施清理中心、PubMed、MEDLINE 和 Cochrane 图书馆，对 1998 年至 2008 年期间的指南、措施和共识文件进行了审查，使用框架评估每个指南或其他证据审查文件对措施制定的可接受性。基于证据水平、重要性、有效性和护理差距的建议声明被纳入候选措施。来自代表性组织的专家小组对这些措施进行了审查。在公众发表意见后，美国神经病学学会和 PCPI 批准了这些措施。
文献检索从 19 项指南和 2 项共识文件中确定了 160 项相关建议声明。系统评估导致 20 项建议声明，专家组对其进行了细化，得出 8 项候选措施。这些措施与发作类型和频率、病因或癫痫综合征、脑电图、神经影像学、抗癫痫药物副作用、安全性问题、难治性癫痫转诊以及有生育能力的妇女问题相关。
有合理的证据基础和共识，可以为癫痫护理质量制定绩效措施。如果提供者采用这些绩效措施，预计将改善癫痫患者的护理。
