Abstracts

Rationale: A previous study by our group (T. Malone, et al. AES Meeting 2011 Abst. 3.162) showed that epileptologists have higher rate of documentation of the AAN Epilepsy Quality Measures (EQM) compared to other neurologists. The aim of this follow up study is to compare the practice patterns of epileptologists and other neurologists in our Institution before and after the publication of the EQM. Methods: We retrospectively reviewed clinic visit data in a random sample of epilepsy patients seen by epileptologists and other neurologists before and after the implementation of EQM that included seizure type and frequency, epilepsy syndrome/etiology, EEG and MRI/CT reviewed or ordered, antiepileptic drug (AED) side effects, referral for surgical treatment, safety counseling and counseling for women with childbearing potential. The two groups were sub grouped by pre and post time period. The two groups of encounters were compared using two sample t-tests for age and duration of epilepsy and chi-square tests for categorical and binary variables. Logistic regression methods were used to assess whether the changes between the pre and post time periods were similar across the two groups of physicians. (P-values <0.05) Results: We included 407 patient visits, 207 of which occurred before the publication of the EQM (92 by an epileptologist and 115 by other neurologist) and 200 after the publication of the EQM introduction (100 by an epileptologist and 100 by other neurologist). There was statistically significant improvement in documentation in post compared to pre period for etiology, MRI/CT, AEDs side effects, safety counseling, counseling for women of child bearing potential and all criteria (P value <0.01) [Table1]. For epileptologists, documentation of EQM during the post period had significantly higher rates for etiology (pre 45%, post 83%), MRI/CT (pre 65%, post 87%), AEDs side effects (pre 65%, post 87%), safety counseling (pre 24%, post 58%), counseling for women of childbearing potential (pre 13%, post 56%) and all criteria. For neurologists, documentation of EQM during the post period had significantly higher rates for etiology, AEDs side effects (Table 1). The differences in pre and post periods between epileptologists and neurologists were significant for etiology (p=0.007), MRI/CT (p=0.013), AEDs side effects (p=0.023) and safety counseling (p=0.03). Conclusions: Our study showed that both epileptologists and other neurologists improved their documentation following the publication of the EQM. Epileptologists improved greater than other neurologists in etiology, MRI/CT ordering or reviewing and safety counseling while other neurologists showed more improvement in relation to reporting AED side effects. Implementation of quality measures has an impact in the delivery of health care.