title: The quality of care for adults with epilepsy: an initial glimpse using the QUIET measure.
abstract: BACKGROUND
  We examined the quality of adult epilepsy care using the Quality Indicators in Epilepsy Treatment (QUIET) measure, and variations in quality based on the source of epilepsy care.
  
  
  METHODS
  We identified 311 individuals with epilepsy diagnosis between 2004 and 2007 in a tertiary medical center in New England. We abstracted medical charts to identify the extent to which participants received quality indicator (QI) concordant care for individual QI's and the proportion of recommended care processes completed for different aspects of epilepsy care over a two year period. Finally, we compared the proportion of recommended care processes completed for those receiving care only in primary care, neurology clinics, or care shared between primary care and neurology providers.
  
  
  RESULTS
  The mean proportion of concordant care by indicator was 55.6 (standard deviation = 31.5). Of the 1985 possible care processes, 877 (44.2%) were performed; care specific to women had the lowest concordance (37% vs. 42% [first seizure evaluation], 44% [initial epilepsy treatment], 45% [chronic care]). Individuals receiving shared care had more aspects of QI concordant care performed than did those receiving neurology care for initial treatment (53% vs. 43%; X(2) = 9.0; p = 0.01) and chronic epilepsy care (55% vs. 42%; X(2) = 30.2; p < 0.001).
  
  
  CONCLUSIONS
  Similar to most other chronic diseases, less than half of recommended care processes were performed. Further investigation is needed to understand whether a shared-care model enhances quality of care, and if so, how it leads to improvements in quality.
authors.affiliation: South Texas Veterans Health Care System, VERDICT REAP, 7400 Merton Minter, San Antonio, TX 78229, USA. pughm@uthscsa.edu
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: Jaya K
authors.initials: JK
authors.lastname: Rao
authors.forename: Gabriel
authors.initials: G
authors.lastname: Shapiro
authors.forename: Ruzan
authors.initials: R
authors.lastname: Avetisyan
authors.forename: Amresh
authors.initials: A
authors.lastname: Hanchate
authors.forename: Kelli
authors.initials: K
authors.lastname: Jarrett
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tabares
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
mesh_terms: D000328:Adult; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D017064:Process Assessment, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D014481:United States; D019037:Urban Health Services; D055815:Young Adult