title: Headache service quality: evaluation of quality indicators in 14 specialist-care centres.
abstract: BACKGROUND
  The study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard).
  
  
  METHODS
  Employing previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient's education and reassurance, convenience and comfort, patient's satisfaction, equity and efficiency of the headache care, outcome assessment and safety.
  
  
  RESULTS
  Our study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this.
  
  
  CONCLUSIONS
  This first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Duisburg-Essen, Hufelandstr, 55, 45122, Essen, Germany. sara.schramm@uk-essen.de.
authors.forename: Sara
authors.initials: S
authors.lastname: Schramm
authors.affiliation: Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Uluduz
authors.affiliation: Hospital da Luz Headache Centre, Neurology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Raquel Gil
authors.initials: RG
authors.lastname: Gouveia
authors.affiliation: Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Copenhagen, Denmark.
authors.forename: Rigmor
authors.initials: R
authors.lastname: Jensen
authors.affiliation: Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Aksel
authors.initials: A
authors.lastname: Siva
authors.affiliation: Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Uygunoglu
authors.affiliation: Department of Neurology, Aversi Clinic, Tbilisi, Georgia.
authors.forename: Giorgadze
authors.initials: G
authors.lastname: Gvantsa
authors.affiliation: Department of Neurology, Aversi Clinic, Tbilisi, Georgia.
authors.forename: Maka
authors.initials: M
authors.lastname: Mania
authors.affiliation: Department of Neurology, Tartu University Clinics, Tartu, Estonia.
authors.forename: Mark
authors.initials: M
authors.lastname: Braschinsky
authors.affiliation: Alexander Vein Headache Clinic, Moscow, Russian Federation.|I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
authors.forename: Elena
authors.initials: E
authors.lastname: Filatova
authors.affiliation: Alexander Vein Headache Clinic, Moscow, Russian Federation.|I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
authors.forename: Nina
authors.initials: N
authors.lastname: Latysheva
authors.affiliation: I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.|University Headache Clinic, Moscow, Russian Federation.
authors.forename: Vera
authors.initials: V
authors.lastname: Osipova
authors.affiliation: University Headache Clinic, Moscow, Russian Federation.
authors.forename: Kirill
authors.initials: K
authors.lastname: Skorobogatykh
authors.affiliation: University Headache Clinic, Moscow, Russian Federation.
authors.forename: Julia
authors.initials: J
authors.lastname: Azimova
authors.affiliation: Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Straube
authors.affiliation: Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany.
authors.forename: Ozan Emre
authors.initials: OE
authors.lastname: Eren
authors.affiliation: Department of Clinical and Molecular Medicine, Sapienza University of Rome, Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Martelletti
authors.affiliation: Department of Clinical and Molecular Medicine, Sapienza University of Rome, Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: De Angelis
authors.affiliation: Department of Clinical and Molecular Medicine, Sapienza University of Rome, Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Negro
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.|Norwegian Advisory Unit on Headaches, St Olavs University Hospital, Trondheim, Norway.
authors.forename: Mattias
authors.initials: M
authors.lastname: Linde
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.|Norwegian Advisory Unit on Headaches, St Olavs University Hospital, Trondheim, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Hagen
authors.affiliation: Neurology Clinic Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Radojicic
authors.affiliation: Neurology Clinic Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Jasna
authors.initials: J
authors.lastname: Zidverc-Trajkovic
authors.affiliation: Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Podgorac
authors.affiliation: Department of Neurology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Paemeleire
authors.affiliation: Department of Neurology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Annelien
authors.initials: A
authors.lastname: De Pue
authors.affiliation: Headache Medical Center Linz Seilerstätte, Linz, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Lampl
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.|Division of Brain Sciences, Imperial College London, London, UK.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Steiner
authors.affiliation: Department of Neurology, Evangelical Hospital Unna, Unna, Germany.|Medical Faculty, University of Duisburg-Essen, Essen, Germany.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Katsarava
mesh_terms: D000328:Adult; D005060:Europe / Q000453:epidemiology; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards; D017060:Patient Satisfaction; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D012017:Referral and Consultation; D063728:Secondary Care Centers / Q000592:standards*; D013038:Specialization / Q000592:standards*; D062606:Tertiary Care Centers / Q000592:standards*
keywords: Global campaign against headache; Headache care; Headache disorders; Service quality evaluation