title: Patient perceptions of physician-documented quality care in epilepsy.
abstract: The aim of this study was to compare physician encounter documentation with patient perceptions of quality of epilepsy care and examine the association between quality and patient assessment of provider communication.
  
  
  
  We identified 505 adult patients with epilepsy aged 18years or older over a 3-year period in two large academic medical centers. We abstracted individual, clinical, and care measures from 2723 electronic clinical notes written by physicians. We then randomly selected 245 patients for a phone interview. We compared patient perceptions of care with the documented care for several established epilepsy quality measures. We also explored the association of patient's perception of provider communication with provider documentation of key encounter interventions.
  
  
  
  There were 88 patients (36%) who completed the interviews. Fifty-seven (24%) refused to participate, and 100 (40%) could not be contacted. Participants and nonparticipants were comparable in their demographic and clinical characteristics; however, participants were more often seen by epilepsy specialists than nonparticipants (75% vs. 61.9%, p<0.01). Quality scores based on patient perceptions differed from those determined by assessing the documentation in the medical record for several quality measures, e.g., documentation of side effects of antiseizure therapy (p=0.05), safety counseling (p<0.01), and counseling for women of childbearing potential with epilepsy (McNemar's p=0.03; intraclass correlation coefficient, ICC=0.07). There was a significant, positive association between patient-reported counseling during the encounter (e.g., personalized safety counseling) and patient-reported scores of provider communication (p=0.05).
  
  
  
  The association between the patient's recollection of counseling during the visit and his/her positive perception of the provider's communication skills highlights the importance of spending time counseling patients about their epilepsy and not just determining if seizures are controlled.
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Boston, United States. Electronic address: lidia.moura@mgh.harvard.edu.
authors.forename: Lidia M V R
authors.initials: LM
authors.lastname: Moura
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Boston, United States. Electronic address: tcarneiro@mgh.harvard.edu.
authors.forename: Thiago S
authors.initials: TS
authors.lastname: Carneiro
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Boston, United States. Electronic address: ethorn@mgh.harvard.edu.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Thorn
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Boston, United States. Electronic address: mseitz@mgh.harvard.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Seitz
authors.affiliation: Massachusetts General Hospital, Department of Medicine, Mongan Institute, Boston, United States; Department of Health Care Policy, Harvard Medical School, Boston, United States. Electronic address: john.hsu@mgh.harvard.edu.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Boston, United States. Electronic address: cole.andrew@mgh.harvard.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
authors.affiliation: Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, United States. Electronic address: barbara.vickrey@mssm.edu.
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Vickrey
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Boston, United States. Electronic address: dhoch@mgh.harvard.edu.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Hoch
mesh_terms: D000328:Adult; D003142:Communication; D004827:Epilepsy / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010465:Perception; D010817:Physician-Patient Relations; D010820:Physicians; D011787:Quality of Health Care; D055815:Young Adult
keywords: Clinical neurology; Epilepsy/seizures; Health services research; Outcome research; Patient experience; Quality of life