title: Association of adherence to epilepsy quality standards with seizure control.
abstract: OBJECTIVE
  We assessed the relationship between adherence to epilepsy quality measures (EQM) and seizure control over 2-3 years in a retrospective cohort study.
  
  
  METHODS
  6150 patients were identified at two large academic medical centers with a primary or secondary diagnosis of epilepsy, were 18-85 years old and seen in outpatient general neurology or epilepsy units between June 2011 and May 2014. Patients were included if: their initial visit was between June 2011 and June 2012, treatment was with ≥1 anti-seizure drug, there was ≥1 visit per year during the timeframe, and seizure frequency was documented at initial and final visits, yielding 162 patients/1055 visits from which socio-demographic, clinical and care quality data were abstracted. Quality care was assessed as (1) percent adherence to up to 8 eligible EQM, and (2) defect-free care (DFC: adherence to all eligible EQM). Seizure control (SC) was defined as ≥50% reduction in average seizures/month between initial and final visits. Chi-square and t-test compared care quality with seizure control. Logistic regression was used to assess the relationships between SC, quality of care and subspecialist involvement.
  
  
  RESULTS
  Care quality, reflected by documentation of seizure frequency, addressing therapeutic interventions, and referral to a comprehensive epilepsy center, all exceeded 80% adherence. Care quality as reflected by documentation of seizure type, etiology or syndrome; assessment of side effects, counseling about epilepsy safety and women's issues, and screening for psychiatric disorders ranged from 40 to 57%. Mean EQM adherence across all applicable measures was associated with greater seizure control (p=0.0098). DFC was low (=8%) and did not covary with seizure control (p=0.55). The SC and non-SC groups only differed on epilepsy etiology (p=0.04). Exploratory analysis showed that mean quality scores are associated with seizure control (OR=4.9 [1.3-18.5], p=0.017) while controlling for the effect of subspecialty involvement as a possible confounding variable.
  
  
  CONCLUSIONS
  Average quality of care but not defect-free care was associated with seizure control in this retrospective cohort.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: lidia.moura@mgh.harvard.edu.
authors.forename: Lidia M V R
authors.initials: LM
authors.lastname: Moura
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: dymendez@partners.org.
authors.forename: Diego Yacaman
authors.initials: DY
authors.lastname: Mendez
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: jdejesus5@partners.org.
authors.forename: Jonathan De
authors.initials: JD
authors.lastname: Jesus
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: raandrade@partners.org.
authors.forename: Rogger A
authors.initials: RA
authors.lastname: Andrade
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA; Department of Health Policy and Management, Harvard T Chan School of Public Health, Boston, MA 02115, USA. Electronic address: jweissman@partners.org.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Weissman
authors.affiliation: Department of Neurology, University of California, Los Angeles, CA 90095-1769, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. Electronic address: bvickrey@ucla.edu.
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Vickrey
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: dhoch@partners.org.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Hoch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004827:Epilepsy / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000592:standards*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Epilepsy care; Epilepsy quality measures; Seizure control