title: Adherence to outpatient epilepsy quality indicators at a tertiary epilepsy center.
abstract: BACKGROUND
  Quality indicators for the treatment of people with epilepsy were published in 2010. This is the first report of adherence to all measures in routine care of people with epilepsy at a level 4 comprehensive epilepsy center in the US.
  
  
  METHODS
  Two hundred patients with epilepsy were randomly selected from the clinics of our comprehensive epilepsy center, and all visits during 2011 were abstracted for documentation of adherence to the eight quality indicators. Alternative measures were constructed to evaluate failure of adherence. Detailed descriptions of all equations are provided.
  
  
  RESULTS
  Objective measures (EEG, imaging) showed higher adherence than counseling measures (safety). Initial visits showed higher adherence. Variations in the interpretation of the quality measure result in different adherence values. Advanced practice providers and physicians had different adherence patterns. No patient-specific patterns of adherence were seen.
  
  
  CONCLUSIONS
  This is the first report of adherence to all the epilepsy quality indicators for a sample of patients during routine care in a level 4 epilepsy center in the US. Overall adherence was similar to that previously reported on similar measures. Precise definitions of adherence equations are essential for accurate measurement. Complex measures result in lower adherence. Counseling measures showed low adherence, possibly highlighting a difference between practice and documentation. Adherence to the measures as written does not guarantee high quality care.
  
  
  CONCLUSIONS
  The current quality indicators have value in the process of improving quality of care. Future approaches may be refined to eliminate complex measures and incorporate features linked to outcomes.
authors.affiliation: University of Rochester Medicine, Golisano Children's Hospital, 601 Elmwood Avenue, Box 777R, Rochester, NY 14642, USA.
authors.forename: R
authors.initials: R
authors.lastname: Pourdeyhimi
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Suite 303, MSC 835, Charleston, SC 29425-8350, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Wolf
authors.affiliation: Department of Healthcare Leadership and Management, Medical University of South Carolina, 151-B Rutledge Ave, Building B, MSC 962, Charleston, SC 29425-9620, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Simpson
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 616/CSB 301, Charleston, SC 29425-6160, USA. Electronic address: krumper4@gmail.com.
authors.forename: G U
authors.initials: GU
authors.lastname: Martz
mesh_terms: D000328:Adult; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D062606:Tertiary Care Centers / Q000592:standards*
keywords: Epilepsy; Health-care reform; Performance; Quality