Does adherence to epilepsy quality measures correlate with reduced epilepsy-related adverse hospitalizations? A retrospective experience.

Abstract

In 2011, the American Academy of Neurology (AAN) established eight epilepsy quality measures (EQMs) for chronic epilepsy treatment to address deficits in quality of care. This study assesses the relationship between adherence to these EQMs and epilepsy-related adverse hospitalizations (ERAHs). A retrospective chart review of 475 new epilepsy clinic patients with an ICD-9 code 345.1-9 between 2010 and 2012 was conducted. Patient demographics, adherence to AAN guidelines, and annual number of ERAHs were assessed. Fisher's exact test was used to assess the relationship between adherence to guidelines (as well as socioeconomic variables) and the presence of one or more ERAH per year. Of the eight measures, only documentation of seizure frequency, but not seizure type, correlated with ERAH (relative risk [RR] 0.343, 95% confidence interval [CI] 0.176-0.673, p=0.010). Among patients in the intellectually disabled population (n=70), only review/request of neuroimaging correlated with ERAH (RR 0.128, 95% CI 0.016-1.009, p=0.004). ERAHs were more likely in African American patients (RR 2.451, 95% CI 1.377-4.348, p=0.008), Hispanic/Latino patients (RR 4.016, 95% CI 1.721-9.346, p=0.016), Medicaid patients (RR 2.217, 95% CI 1.258-3.712, p=0.009), and uninsured patients (RR 2.667, 95% CI 1.332-5.348, p=0.013). In this retrospective series, adherence to the eight AAN quality measures did not strongly correlate with annual ERAH.