Abstracts

Rationale: The Quality Indicators in Epilepsy Treatment (QUIET) is a tool to assess the quality of care provided to epilepsy patients. Data suggests that there are disparities in quality of care given to epilepsy patients based on insurance status. The aim of this study is to investigate if epilepsy care in a general neurology, Medicaid-only, resident clinic is concordant with the QUIET guidelines and explore which areas are not concordant so as to inform future educational programming.  Methods: Data from a single academic center was used. A chart review was performed using the hospital’s Clinical Data Warehouse. Patient charts were reviewed if there was a neurology resident clinic visit between April and September 2017 with epilepsy-related ICD-10 codes. Demographic data and data relevant to the QUIET guidelines was reviewed. Results: One hundred eighty seven clinic visits were identified; 169 were confirmed for initial seizure or epilepsy and 17 were for other reasons. Mean age was 51 years, and 98 were women. Thirty-six (21%) were initial visits and 133(78%) were follow-up visits. During new visits, EEG and brain imaging was ordered/reviewed in 33(92%) and 33(92%) patients respectively. Thirty-one (94%) had their seizure type classified. Thirty-three patients were identified as requiring anti-epileptic drugs (AEDs) of which 20(55%) were prescribed monotherapy Three(8%) and 2(6%) patients received information on seizure safety and driving, respectively and 6(17%) patients were physically incapable of driving. During follow up visits, 114(86%) notes classified seizure type, 127(96%) estimated seizure frequency, 68(51%) documented AED side effects, 19(14%) screened for depression, 19(14%) patients received education on seizure safety, 9(7%) received education on driving and 6(5%) patients were physically incapable of driving. QUIET recommends assessment of bone health for patients receiving antiepileptic drug (AED) for = 2 years. The length of treatment was unable to be obtained through this chart review, however only 2(1.5%) patients had bone scans and 16(12%) had Vitamin D levels. There were 37 women between 12-44 years old. In those patients; 9(24%) were prescribed either valproic acid or topiramate, 12(32%) were prescribed folate and 7(19%) educated teratogenicity or risks of epilepsy and pregnancy. Conclusions: In this neurology resident clinic, physician notes were most concordant with documentation of seizure frequency (96%), seizure type (94% at new visit, 86% at follow-up), ordering/reviewing EEGs (92%) or brain imaging (92%). Physicians were least concordant with prescribing monotherapy (55%), documenting AED side effects (51%), prescribing folate (32%), counseling on AED teratogenicity and/or risk of epilepsy and pregnancy (19%), checking vitamin D levels (12%), screening for depression (14%), counseling on seizure safety  (8% at new visit; 14% at follow-up) and driving (6% at new visit; 7% at follow-up), obtaining a bone scan (1.5%). These results are limited by the assumption that lack of documentation meant these topics were not addressed at the clinic visit. The measures with which the physicians’ notes were more concordant are topics that are often also addressed in the acute care setting. This might reflect a greater comfort level among residents with acute management of neurological issues as opposed to chronic care. Though this study reflects the experience in one neurology residency program, many programs are faced with the challenge of ensuring adequate education in ambulatory neurology topics. These results can guide educational programming for the neurology residents. Funding: None