title: Quality improvement in neurology: AAN epilepsy quality measures: Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology.
abstract: OBJECTIVE
  Epilepsy is a common neurologic condition with significant personal, societal, medical, and economic burdens. There are considerable gaps in the quality of care delivered. Measuring the quality of care delivered is the first step to its improvement. Performance measures are easily identified and quantitated ways to assess whether specific activities were carried out during a patient encounter. Therefore, epilepsy performance measures were derived through a standardized systematic process and may be the basis for pay-for-performance initiatives and maintenance of certification requirements.
  
  
  METHODS
  Epilepsy measures were developed through the American Medical Association-convened Physician Consortium for Performance Improvement (PCPI) independent measure development process, which marked the first time a medical specialty society followed this process. Guidelines, measures, and consensus papers reviewed for the period 1998 to 2008 using the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, PubMed, MEDLINE, and the Cochrane Library were evaluated using a framework to determine the acceptability of each guideline or other evidence review document for measures development. Recommendation statements based on level of evidence, importance, validity, and gap in care were developed into candidate measures. A panel of experts from representative organizations vetted the measures. A period of public comment was followed by approval from the American Academy of Neurology and the PCPI.
  
  
  RESULTS
  Literature search identified 160 relevant recommendation statements from 19 guidelines and 2 consensus papers. Systematic assessment resulted in 20 recommendation statements that were refined to 8 candidate measures by the expert panel. The measures are relevant to seizure type and frequency, etiology or epilepsy syndrome, EEG, neuroimaging, antiepileptic drug side effects, safety issues, referral for refractory epilepsy, and issues for women of childbearing potential.
  
  
  CONCLUSIONS
  There is a reasonable evidence base, and consensus for, deriving performance measures for quality of epilepsy care. It is anticipated that implementation of these performance measures will improve care for patients with epilepsy if adopted by providers.
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: N B
authors.initials: NB
authors.lastname: Fountain
authors.forename: P C
authors.initials: PC
authors.lastname: Van Ness
authors.forename: R
authors.initials: R
authors.lastname: Swain-Eng
authors.forename: S
authors.initials: S
authors.lastname: Tonn
authors.forename: C T
authors.initials: CT
authors.lastname: Bever
mesh_terms: D000047:Academies and Institutes / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D016208:Databases, Factual / Q000706:statistics & numerical data; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D009462:Neurology / Q000592:standards*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D014481:United States