title: A proposed roadmap for inpatient neurology quality indicators.
abstract: OBJECTIVE
  In recent years, there has been increasing pressure to measure and report quality in health care. However, there has been little focus on quality measurement in the field of neurology for conditions other than stroke and transient ischemic attack. As the number of evidence-based treatments for neurological conditions grows, so will the demand to measure the quality of care delivered. The purpose of this study was to review essential components of hospital performance measures for neurological disease and propose potential quality indicators for commonly encountered inpatient neurological diagnoses.
  
  
  METHODS
  We determined the most common inpatient neurological diagnoses at a major tertiary care medical center by reviewing the billing database. We then searched PubMed and the National Guidelines Clearinghouse to identify treatment guidelines for these conditions. Guideline recommendations with class I/level A evidence were evaluated as possible quality indicators.
  
  
  RESULTS
  We found 94 guidelines for 14 inpatient neurological conditions other than stroke and transient ischemic attack. Of these, 36 guidelines contained at least 1 recommendation with class I evidence. Based on these, potential quality indicators for intracerebral hemorrhage, subarachnoid hemorrhage, pneumococcal meningitis, coma following cardiac arrest, encephalitis, Guillain-Barre syndrome, multiple sclerosis, and benign paroxysmal positional vertigo are proposed.
  
  
  CONCLUSIONS
  There are several inpatient neurological conditions with treatments or diagnostic test routines supported by high levels of evidence that could be used in the future as quality indicators.
authors: University of California, San Francisco, Department of Neurology.
authors: Vanja C
authors: VC
authors: Douglas
authors: S Andrew
authors: SA
authors: Josephson
keywords: brain; central nervous system diseases; cerebrovascular disorders; epidemiology; hypoxia-ischemia; intracranial hemorrhages; outcomes; stroke delirium
references: Eur J Neurol. 2006 Jun;13(6):560-72
references: 16796580
references: Neurology. 2002 Jan 22;58(2):169-78
references: 11805241
references: Eur J Neurol. 2005 Nov;12(11):817-27
references: 16241970
references: Clin Infect Dis. 2000 Apr;30(4):710-8
references: 10770733
references: JAMA. 1999 May 26;281(20):1900-5
references: 10349893
references: Lancet. 2007 Mar 24;369(9566):1000-15
references: 17382827
references: Eur J Neurol. 2005 Aug;12(8):575-81
references: 16053464
references: Neurology. 2008 Sep 2;71(10):766-73
references: 18765653
references: Am J Prev Med. 1998 Apr;14(3 Suppl):14-21
references: 9566932
references: Eur J Neurol. 2005 May;12(5):331-43
references: 15804262
references: Neurology. 2003 Sep 23;61(6):736-40
references: 14504313
references: Eur J Neurol. 2006 Oct;13(10):1066-77
references: 16987158
references: Circulation. 1994 Nov;90(5):2592-605
references: 7955232
references: Arch Intern Med. 2004 Jul 12;164(13):1405-12
references: 15249349
references: Eur J Neurol. 2006 May;13(5):445-50
references: 16722966
references: Eur J Neurol. 2008 Jul;15(7):649-59
references: 18582342
references: Int J Qual Health Care. 2001 Dec;13(6):489-96
references: 11769752
references: Stroke. 2002 Jul;33(7):1851-6
references: 12105365
references: Eur J Neurol. 2008 Sep;15(9):893-908
references: 18796075
references: Neurology. 2005 Aug 23;65(4):510-2
references: 16116106
references: N Engl J Med. 1999 Mar 4;340(9):669-76
references: 10053175
references: Transfus Med Rev. 2007 Apr;21(2 Suppl 1):S57-107
references: 17397768
references: Neurology. 2006 Jul 25;67(2):203-10
references: 16864809
references: Stroke. 2007 Jun;38(6):2001-23
references: 17478736
references: Lancet. 2005 Sep 3-9;366(9488):809-17
references: 16139655
references: Ann Neurol. 2006 Sep;60(3):301-13
references: 16912978
references: Neurology. 2004 Apr 27;62(8):1261-73
references: 15111660
references: Neurology. 2004 Apr 27;62(8):1252-60
references: 15111659
references: Epilepsia. 2006 Jul;47(7):1094-120
references: 16886973
references: Neurology. 2000 Sep 26;55(6):754-62
references: 10993991
references: Womens Health Issues. 1999 Jul-Aug;9(4):184-92
references: 10405590
references: JAMA. 1998 Sep 16;280(11):1000-5
references: 9749483
references: J Emerg Med. 1999 Jan-Feb;17(1):137-44
references: 9950404
references: Clin Infect Dis. 2004 Nov 1;39(9):1267-84
references: 15494903
references: Cerebrovasc Dis. 2006;22(4):294-316
references: 16926557
references: Neurology. 2008 May 27;70(22):2067-74
references: 18505980
references: CJEM. 2006 Mar;8(2):106-8
references: 17175871
references: Otolaryngol Head Neck Surg. 2008 Nov;139(5 Suppl 4):S47-81
references: 18973840
references: Lancet. 2007 Mar 24;369(9566):1016-26
references: 17382828
references: Neurology. 2003 Sep 9;61(5):602-11
references: 12963748
references: N Engl J Med. 2003 Jun 26;348(26):2635-45
references: 12826639
references: Eur J Neurol. 2006 Apr;13(4):313-25
references: 16643308
references: Eur J Neurol. 2005 Dec;12(12):939-46
references: 16324087
references: Clin Infect Dis. 2008 Aug 1;47(3):303-27
references: 18582201