癫痫质量标准的依从性与癫痫发作控制的关联。

Association of adherence to epilepsy quality standards with seizure control.

作者信息

Moura Lidia M V R, Mendez Diego Yacaman, Jesus Jonathan De, Andrade Rogger A, Weissman Joel S, Vickrey Barbara G, Hoch Daniel B

机构信息

Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.

Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA; Department of Health Policy and Management, Harvard T Chan School of Public Health, Boston, MA 02115, USA.

出版信息

Epilepsy Res. 2015 Nov;117:35-41. doi: 10.1016/j.eplepsyres.2015.08.008. Epub 2015 Aug 14.

DOI:10.1016/j.eplepsyres.2015.08.008

PMID:26370916

Abstract

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.

摘要

目的

在一项回顾性队列研究中，我们评估了癫痫质量指标（EQM）的依从性与2至3年癫痫发作控制之间的关系。

方法

在两家大型学术医疗中心识别出6150例患者，这些患者患有原发性或继发性癫痫诊断，年龄在18至85岁之间，于2011年6月至2014年5月期间在门诊普通神经科或癫痫科就诊。符合以下条件的患者被纳入研究：他们的首次就诊时间在2011年6月至2012年6月之间，使用≥1种抗癫痫药物进行治疗，在该时间段内每年至少就诊1次，并且在首次和末次就诊时记录了癫痫发作频率，由此产生了162例患者/1055次就诊，从中提取了社会人口统计学、临床和护理质量数据。将优质护理评估为：（1）对多达8项合格EQM的依从百分比，以及（2）无缺陷护理（DFC：对所有合格EQM的依从）。癫痫发作控制（SC）定义为首次和末次就诊之间平均每月癫痫发作减少≥50%。采用卡方检验和t检验比较护理质量与癫痫发作控制情况。使用逻辑回归评估SC、护理质量和专科医生参与之间的关系。

结果

癫痫发作频率记录、治疗干预措施以及转诊至综合癫痫中心所反映的护理质量，其依从率均超过80%。癫痫发作类型、病因或综合征的记录；副作用评估、癫痫安全和女性问题咨询以及精神疾病筛查所反映的护理质量范围为40%至57%。所有适用指标的平均EQM依从性与更好的癫痫发作控制相关（p = 0.0098）。DFC较低（=8%），且与癫痫发作控制无相关性（p = 0.55）。SC组和非SC组仅在癫痫病因方面存在差异（p = 0.04）。探索性分析表明，在控制专科医生参与作为可能的混杂变量的影响时，平均质量得分与癫痫发作控制相关（OR = 4.9 [1.3 - 18.5]，p = 0.017）。