Quality Improvement In Neurology Research Articles

Amyotrophic Lateral Sclerosis Quality Measurement Set 2022 Update: Quality Improvement in Neurology.

Amyotrophic Lateral Sclerosis Quality Measurement Set 2022 Update: Quality Improvement in Neurology.

Quality Improvement in Neurology: 2020 Parkinson Disease Quality Measurement Set Update.

Parkinson disease (PD) is the second most common neurodegenerative disorder, after Alzheimer disease,1 and the number of individuals with PD worldwide more than doubled between 1990 and 2015.2 In 2016, PD affected an estimated 6.1 million people globally.3 In the United States, an estimated 680,000 individuals ≥45 years of age had PD in 2010.4 These numbers were projected to rise to 930,000 in 2020 and to reach 1,238,000 by 2030.4 Both motor (rest tremor, bradykinesia, rigidity) and nonmotor (including but not limited to neuropsychiatric, autonomic, and sensory) symptoms of PD contribute to decreased quality of life5 and neurologic disability.3

Quality Improvement in Neurology: Concussion Quality Measurement Set.

Concussion represents the immediate and transient symptoms of a mild traumatic brain injury (TBI),1 and is defined as a clinical syndrome of biomechanically induced alteration of brain function.2 The term “concussion” is often used interchangeably with “mild traumatic brain injury.”1

Quality Improvement in Neurology

Multiple sclerosis (MS) is a disabling immune-mediated disease of the CNS and considered one of the health conditions with the highest annual spending growth paid by both public and private insurance.1 Health care spending in the United States for MS was reported as $13.9 billion in 2016.1 The estimated cumulated (over 10 years) prevalence of MS among adults in the United States in 2010 was approximately 727,000.2 In 2017, that number was substantially higher, approximately 914,000.2,3 The prevalence is higher among women, with a female: male ratio of 2.8.2 Improving high-quality care for these patients can lead to improved outcomes, reduced spending, and better quality of life.

Quality Improvement in Neurology: Epilepsy Quality Measurement Set 2017 Update.

Quality Improvement in Neurology: Epilepsy Quality Measurement Set 2017 Update.

Quality Improvement in Neurology: Headache Quality Measurement Set.

Quality Improvement in Neurology: Headache Quality Measurement Set.

Quality improvement in neurology: Headache Quality Measurement Set.

Headache is the most frequent reason for a person to seek care from a neurologist and is the most common subspecialty practice focus identified by neurologists.1 Although headache is most commonly encountered in primary care,2,3 it is also the fourth leading cause of emergency department visits,4 with 1.2 million encounters annually in US emergency departments for migraine alone.5

Quality Improvement in Neurology: Headache Quality Measurement Set.

Quality Improvement in Neurology: Headache Quality Measurement Set.

Quality improvement in neurology: Neurology Outcomes Quality Measurement Set.

One in 6 Americans live with a neurologic disease.1–3 Recent evidence suggests that the number of people dying from and affected by these disorders has increased substantially in the past 25 years, contributing to a higher health loss across the lifespan.2 The American Academy of Neurology's (AAN's) mission is in part to promote the highest-quality patient-centered neurologic care for these patients, and the AAN's leadership in quality improvement initiatives and developing outcome measures is a conveyance of this mission. Quality, as defined by the National Academy of Medicine, is “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”4 Quality improvement is “systematic, data-guided activities designed to bring about immediate improvements in health care delivery” and is considered “an intrinsic part of normal health care operations.”5 Data from outcome measures can be effectively used to establish a baseline of care quality delivered within a given health care unit (e.g., multispecialty group)5,6 and guide the implementation and ongoing evaluation of quality improvement initiatives intended to improve care quality and delivery.6 Increasing demands to provide health care outcomes data from patients and payers and the need for neurologic providers to have these data available to assist in care planning necessitated the AAN's former Quality and Safety Subcommittee to recommend the seating of a small work group to develop neurologic outcome quality measures, which would be applicable broadly across major neurologic diseases.

Quality improvement in neurology: Mild cognitive impairment quality measurement set.

Mild cognitive impairment (MCI) is a syndrome increasingly recognized in older adults and has become a major focus of clinical care and research. MCI is used to describe acquired objective cognitive deficits that are insufficiently severe to affect most usual daily activities. A report of cognitive difficulty or change is insufficient to recognize MCI; objective measures documenting deficits are required. Maintenance of daily function distinguishes MCI from the dementia syndrome, yet it is particularly important because of its high risk for subsequent development of progressive dementia, particularly Alzheimer disease (AD) dementia. Patients with MCI may or may not recognize their impairments; consequently, concerns raised by friends or family and periodic cognitive health screening may be required to identify its presence. The syndrome can be further delineated as impairing a single or multiple cognitive domains and is often classified as either amnestic or nonamnestic.1 Amnestic MCI in particular often represents a prodromal form of AD dementia, although it is important to acknowledge that reversion to cognitive normalcy also occurs with some frequency.2

Quality improvement in neurology: Universal neurology quality measurement set: Executive summary.

The American Academy of Neurology (AAN) formed a work group to evaluate quality measures applicable to a general neurologist. Currently available general measurement options—such as smoking, immunization, and weight—although relevant to a wide patient population, do not, for the most part, reflect the practice of neurology. Rather than developing quality measures specific to one neurologic subspecialty, the goal of this project was to develop quality measures that are universally applicable to neurology.

Quality improvement in neurology: Epilepsy Quality Measurement Set 2017 update.

Epilepsy is a common condition in the United States. It is estimated that 1.2% of the population or 3.4 million people have epilepsy. This figure may be underestimated because of potential repercussions and stigma in disclosing epilepsy.1 Studies have shown that people with epilepsy are more likely to be unemployed or unable to work, have lower annual household incomes, be obese and physically inactive, and be less likely to marry.2,3 People with epilepsy can have poor overall health status, impaired intellectual and physical functioning, elevated risk of accidents and injuries, and negative side effects from antiseizure medications.2,3 It is estimated the annual direct medical cost of epilepsy in the United States is $9.6 billion; combined with indirect costs, the total rises to $15.5 billion yearly.2

Quality Improvement in Neurology: Neurotology Quality Measurement Set.

Quality Improvement in Neurology: Neurotology Quality Measurement Set.

Quality improvement in neurology: Neuro-Oncology Quality Measurement Set.

Quality improvement in neurology: Neuro-Oncology Quality Measurement Set.

Quality improvement in neurology: Neuro-oncology quality measurement set.

Over 78,000 new CNS tumors are diagnosed each year in the United States, nearly one-third of which are primary malignant brain tumors,1 and the US prevalence of primary brain tumors is approximately 688,000.2 While primary CNS neoplasms represent only 1.4% of new cancer diagnoses, approximately 2.7% of cancer deaths are related to CNS neoplasms,3 and it is estimated that 16,947 deaths will result from primary CNS tumors in 2017.1 Population-based studies have shown that socioeconomic disparities are present within the neuro-oncology community,4–7 highlighting the need for a unified system of quality metrics in this growing field. Toward this end, several authors have published work on quality-based practice and on the inclusion of patient-reported outcomes in brain tumor care.8–12

Quality improvement in neurology: Child neurology quality measure set: Executive summary.

Childhood neurologic disorders, as a group, include relatively common conditions such as migraine (prevalence between 3% and 10.6% in children 3–15 years of age1,2), transient tic disorders (TDs) (3%),3 and specifically Tourette syndrome (TS) (0.8%),3 and rarer disorders such as infantile spasms that may occur in only about 1,200 infants each year in the United States. These disorders account for a disproportionately higher number of emergency department visits, intensive care admissions, deaths, and higher costs when compared to other childhood illness.4 Generally, delivery of quality care should improve outcomes and result in decreased unnecessary utilization of health services.4

Quality improvement in neurology: Stroke and Stroke Rehabilitation Quality Measurement Set update.

Stroke is the fifth leading cause of death in the United States and the second leading cause of disability worldwide.1,2 “On average, every 40 seconds, someone in the United States has a stroke, and someone dies of one approximately every 4 minutes.”3 Each year, nearly 800,000 people experience stroke, with up to 185,000 experiencing recurrent stroke events.3 Strokes occur at any age, and risk increases with age.4 Nearly half of older stroke survivors experience moderate to severe disability.5

Quality improvement in neurology: Essential Tremor Quality Measurement Set.

Essential tremor (ET) is one of the most common movement disorders in the world, with prevalence rates in the general population ranging from 0.4% to 4.6%.1,2 The incidence of ET increases with age,1 with the average age at onset in mid-to-late 40s.3 ET is estimated to affect as many as 7 to 10 million Americans.3,4 Clinically, ET is characterized by bilateral, symmetric, postural tremor in hands and forearms, with or without kinetic tremor, in the absence of abnormal posturing or task specificity.5 ET can also affect lower extremities, head, and voice.6,7 Symptoms may be barely noticeable, or severe and disabling. The authors thank the ET Quality Measurement Set Work Group members for their dedication, time, energy, contributions, and work that supported the development of this manuscript: Theresa A. Zesiewicz, MD, FAAN (American Academy of Neurology); Kelly L. Sullivan, PhD, MSPH (American Academy of Neurology); Paras Bhattarai, MD, MBBS (American Academy of Neurology); Kelvin L. Chou, MD (American Academy of Neurology); Peter Hedera, MD, PhD (American Academy of Neurology); Janis M. Miyasaki, MD, FAAN (American Academy of Neurology); Diego R. Torres-Russotto, MD (American Academy of Neurology); Laurice Yang, MD (American Academy of Neurology); Margaret M. Lambert, RN, BSN, CNRN (American Association of Neuroscience Nurses); Julie Barkmeier-Kraemer, PhD, CCC-SLP (American Speech-Language-Hearing Association); Ellen Air, MD, PhD, FAANS (American Society for Stereotactic and Functional Neurosurgery); Jane Ott, PT, DPT, NCS (American Society for Stereotactic and Functional Neurosurgery); Lauren Seeberger, MD, FAAN (American Society for Stereotactic and Functional Neurosurgery); Shari Finsilver, MS (International Essential Tremor Foundation); Fatta B. Nahab, MD (Movement Disorder Society); Dietrich Haubenberger, MHSc, MD (National Institute of Neurologic Disorders and Stroke/NIH); Anna D. Hohler, MD, FAAN (American Academy of Neurology facilitator); Marcus Ponce de Leon, MD, FAAN (American Academy of Neurology facilitator); Amy Bennett, JD (American Academy of Neurology staff); Gina Gjorvad (American Academy of Neurology staff); Katie Hentges (American Academy of Neurology staff); Erin Lee (American Academy of Neurology staff); Karen Lundgren, MBS (American Academy of Neurology staff); Becky Schierman, MPH (American Academy of Neurology staff).

Quality improvement in neurology: Inpatient and emergency care quality measure set: Executive summary.

The emergence of inpatient neurologic specialists including neurohospitalists and neurointensivists has led to an increased focus on the quality of neurologic care delivered in the hospital. Each year, there are over 1.5 million nonsurgical neurologic hospital discharges in the United States, making neurology a large inpatient specialty even without accounting for nonadmitted emergency patients.1 National quality metrics in other non-neurologic specialties have focused primarily on inpatient care since hospitals, insurers, professional organizations, and the general public have turned their attention to outcomes achieved during and following hospitalization. Many of these metrics have been applied to neurology patients, despite their not being developed with neurology-specific patient populations or disorders in mind. This gap highlights the need for measures for neurology patients in both inpatient and emergency settings. The authors thank the Inpatient and Emergency Neurology Quality Measurement Set Work Group members for their dedication, time, energy, contributions, and work that supported the development of this manuscript: John Ferro, MD, MS, FAAN (co-chair) (American Academy of Neurology); S. Andrew Josephson, MD, FAAN (co-chair) (Neurohospitalist Society); Paul Vespa, MD, FAAN (co-chair) (Neurocritical Care Society); Rohit Das, MD, MPH (American Academy of Neurology); David Gloss, MD (American Academy of Neurology); David Jones, MD (American Academy of Neurology); William Mack, MD, MS, FAANS, FAHA (American Association of Neurological Surgeons; Congress of Neurological Surgeons); Virginia Prendergast, PhD, NP-C (American Association of Neuroscience Nurses); Chip Truwit, MD (American College of Radiology/American Society of Neuroradiology); Paul Van Ness, MD (American Epilepsy Society); Michael Perskin, MD (American Geriatrics Society); Sanjeev Sockalingam, MD, FRCPC (American Psychiatric Association); Charlotte Jones, MD, PhD, MSPH (Child Neurology Society); Kevin Sheth, MD, FAAN, FNCS, FAHA (Neurocritical Care Society); Navaz Karanjia, MD (Neurocritical Care Society); Salvador Cruz-Flores, MD, MPH, FAAN (Neurocritical Care Society); Corey Fehnel, MD, MPH (Neurocritical Care Society); John Probasco, MD (Neurohospitalist Society); Mark Rubin, MD (Neurohospitalist Society); Jennifer Simpson, MD (Neurohospitalist Society); Jana Wold, MD (Neurohospitalist Society); Adam Cohen, MD (American Academy of Neurology facilitator); Adam Webb, MD (American Academy of Neurology facilitator); Amy Bennett, JD (American Academy of Neurology staff); Gina Gjorvad (American Academy of Neurology staff); Erin Lee (American Academy of Neurology staff); Becky Schierman, MPH (American Academy of Neurology staff).

Quality Improvement in Neurology: Dementia Management Quality Measurement Set Update.

Dementia is a neurologic condition manifested by a substantial decline in multiple cognitive abilities that collectively render a person unable to function at expected levels and progressively impede independent ability to perform everyday activities. For decades, public health officials have warned of the coming tsunami of Alzheimer disease (AD), and dementia has even been characterized as the dominant scourge of modern times, replacing cancer.1 Recently, hopeful signs have appeared, including reports from some longitudinal research studies that incidence of dementia is declining,2 and from the federal government that research funding for AD and other dementias will approach $1 billion USD in 2017.3 The authors thank all the Dementia Management Update Quality Measurement Set Work Group members for their dedication, time, energy, contributions and work that supported the development of this manuscript: Amy E. Sanders, MD, MS, FAAN (American Academy of Neurology); Robert Roca, MD (American Psychiatric Association); Piero Antuono, MD (American Academy of Neurology); Kelly Sullivan, PhD (American Academy of Neurology); Karl Goodkin, MD, PhD, DFAPA (American Psychiatric Association); Donovan Maust, MD, MS (American Psychiatric Association); Michael Lubin, MD, MACP (American College of Physicians); Sam Fazio, PhD (Alzheimer's Association); Ann Knutson (Alzheimer's Association); Robert O'Keefe, MA (Alzheimer's Association); Eric Tangalos, MD, FACP, AGSF, CMD (AMDA–The Society for Post-Acute and Long-Term Care Medicine); Glenn Smith, PhD (American Academy of Clinical Neuropsychology and American Psychological Association); Brian Unwin, MD, FAAFP (American Academy of Family Physicians); Joseph Shega, MD (American Academy of Hospice and Palliative Medicine); Dale Strasser, MD (American Academy of Physical Medicine and Rehabilitation); Michele Grigaitis, DNP, FNP-BC, CNRN (American Association of Neuroscience Nurses); Jerry Johnson, MD (American Geriatric Society); Mary Kathleen Owens, RN MSN, C-NE, RAC-CT (American Health Care Association and Gerontological Advanced Practice Nurses Association); Catherine Piersol, PhD, OTR, FAOTA (American Occupational Therapy Association); Lise McCarthy, PT, DPT, GCS (American Physical Therapy Association); Kathleen Welsh-Bohmer, PhD, ABPP (American Psychological Association); David Webster, MD, MBA (Humana); James Galvin, MD, MPH, FANA (Lewy Body Dementia Association); Daniel Marson, PhD, JD (National Academy of Neuropsychology); Richard Fortinsky, PhD (The Gerontological Society of America); Marsden McGuire, MD (Veteran's Affairs); John Absher, MD (American Academy of Neurology Facilitator); James Nininger, MD (American Psychiatric Association Facilitator); Amy Bennett, JD (American Academy of Neurology Staff); Gina Gjorvad (American Academy of Neurology Staff); Erin Hagen (American Academy of Neurology Staff); Becky Schierman, MPH (American Academy of Neurology Staff); Samantha Shugarman, MS (American Psychiatric Association Staff); and Kristin Kroeger (American Psychiatric Association Staff). The authors also thank Jean O'Keefe for participation and the individuals and organizations who offered public comments.