Cross-country measures for monitoring epilepsy care.
OBJECTIVE
The International League Against Epilepsy (ILAE) Commission on Healthcare Policy in consultation with the World Health Organization (WHO) examined the applicability and usefulness of various measures for monitoring epilepsy healthcare services and systems across countries. The goal is to provide planners and policymakers with tools to analyze the impact of healthcare services and systems and evaluate efforts to improve performance.


METHODS
Commission members conducted a systematic literature review and consulted with experts to assess the nature, strengths, and limitations of the treatment gap and resource availability measures that are currently used to assess the adequacy of epilepsy care. We also conducted a pilot study to determine the feasibility and applicability of using new measures to assess epilepsy care developed by the WHO including Disability-Adjusted Life Years (DALYs), responsiveness, and financial fairness.


RESULTS
The existing measures that are frequently used to assess the adequacy of epilepsy care focus on structural or process factors whose relationship to outcomes are indirect and may vary across regions. The WHO measures are conceptually superior because of their breadth and connection to articulated and agreed upon outcomes for health systems. However, the WHO measures require data that are not readily available in developing countries and most developed countries as well.


CONCLUSIONS
The epilepsy field should consider adopting the WHO measures in country assessments of epilepsy burden and healthcare performance whenever data permit. Efforts should be made to develop the data elements to estimate the measures.
Begley
Charles E
CE
School of Public Health, University of Texas 77030, USA. charles.e.begley@uth.tmc.edu
Baker
Gus A
GA
Beghi
Ettore
E
Butler
James
J
Chisholm
Daniel
D
Langfitt
John T
JT
Levy
Pierre
P
Pachlatko
Christoph
C
Wiebe
Samuel
S
Donaldson
Karen Lee
KL
D017954:Africa South of the Sahara / Q000453:epidemiology; D017281:Cost of Illness; D003431:Cross-Cultural Comparison; D019033:Delivery of Health Care, Integrated / Q000592:standards / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017048:Health Care Costs / Q000592:standards / Q000706:statistics & numerical data; D019538:Health Care Surveys / Q000379:methods / Q000706:statistics & numerical data; D006291:Health Policy; D006301:Health Services Needs and Demand; D006302:Health Services Research / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D019057:Quality-Adjusted Life Years; D006113:United Kingdom / Q000453:epidemiology; D014944:World Health Organization