Abstracts

Rationale: The updated American Academy of Neurology (AAN) quality measures set out to provide practioners with a guide to topics that should be discussed with every patient with epilepsy, with the aim of standardizing care and improving patient outcomes. Our study sought to measure adherence to these guidelines in a resident teaching clinic within a level 4 comprehensive epilepsy center to find potential gaps in physician practice patterns.Methods: A retrospective chart review was performed on 40 patients with a diagnosis of epilepsy. The patients were seen in the resident clinic for a follow-up appointment between August 1, 2013 and May 31, 2015, with care spanning over 14 resident physicians. Charts were assessed for documentation of adherence to the seven quality measure guidelines, including seizure frequency and intervention, seizure etiology and type, side effects of therapy, epilepsy safety, psychiatric and behavioral health issues, counseling of women of childbearing potential, and referral for intractable epilepsy. The results were utilized to build a tool within an electronic medical records system to facilitate documentation in future encounters.Results: Multiple quality measures approached 100% documentation, including seizure frequency and etiology or syndrome. However, there was significantly less documentation of particular measures, including occurrence and intervention of side effects (46.5%) and psychiatric screening (37.5%). Childbearing counseling, with or without folate supplementation, was documented in women 18-45 years old in 31% of cases. Refractory epilepsy leading to a referral to an attending epileptologist was only 13%. Our department includes a Level 4 National Association of Epilepsy Centers (NAEC) accredition with 4 epilepsy specialists. There is no barrier to referral to the epilepsy faculty for teaching clinic patients.Conclusions: There was great variability in the rate of documentation for each quality measure. Objective measures were more commonly documented than counseling measures. Decreased adherence to counseling measures may be due to a discrepancy between practice and documentation. There may be an element of ""documentation fatigue"" as the elements which occur early in an encounter are well documented, but information which would be exchanged later in the encounter is not consistently recorded. Improved documentation strategies, such as an electronic medical record tool, may lead to a clearer assessment of patient care, but must be implemented in a way that does not distract the trainee from listening to the patient's story. An electronic tool must also be receptive to patient focused care, and help a trainee develop a plan for each patient that incorporates the guidelines. This study provides a baseline as to which improvement goals can be compared.