Quality improvement in neurology (original) (raw)

The American Academy of Neurology (AAN) formed a work group to evaluate quality measures applicable to a general neurologist. Currently available general measurement options-such as smoking, immunization, and weight-although relevant to a wide patient population, do not, for the most part, reflect the practice of neurology. Rather than developing quality measures specific to one neurologic subspecialty, the goal of this project was to develop quality measures that are universally applicable to neurology. Quality measures use clinical practice guideline recommendation statements and research to generate a measurable action a provider may perform. Quality measures do not generate new evidence or recommendations. Quality measures are one way that guideline recommendations are operationalized for use in clinical practice. Eight quality measure groups were determined to have relevance across the practice of neurology. Falls outcome and plan of care Falls are a leading cause of death in persons aged 65 years and older. 1 In addition, multiple neurologic conditions increase the risk of falling in younger persons. In persons who do fall and who require hospitalization, the cost is approximately 39,000perpatient.2Thisqualitymeasureaddressesthepercentageofpatientswhoreportedafallduringthemeasurementandwhohadaplanofcaredocumented.ActivitycounselingforbackpainBackpainisafrequentcauseofsickdaysforthoseintheworkforceandafrequentcomplaintinneurologicpractice.3In1990,itwasreportedthatlowbackpainwasthefifthmostcommonreasontoseeaphysician.4A2002NationalHealthInterviewSurveyindicatedthatonefourthofUSadultsreportedbackpaininthelast3−monthperiod.5A2006socioeconomicstudyshowedtotalcostsattributabletolowbackpainintheUnitedStateswereestimatedat39,000 per patient. 2 This quality measure addresses the percentage of patients who reported a fall during the measurement and who had a plan of care documented. Activity counseling for back pain Back pain is a frequent cause of sick days for those in the workforce and a frequent complaint in neurologic practice. 3 In 1990, it was reported that low back pain was the fifth most common reason to see a physician. 4 A 2002 National Health Interview Survey indicated that one fourth of US adults reported back pain in the last 3-month period. 5 A 2006 socioeconomic study showed total costs attributable to low back pain in the United States were estimated at 39,000perpatient.2Thisqualitymeasureaddressesthepercentageofpatientswhoreportedafallduringthemeasurementandwhohadaplanofcaredocumented.ActivitycounselingforbackpainBackpainisafrequentcauseofsickdaysforthoseintheworkforceandafrequentcomplaintinneurologicpractice.3In1990,itwasreportedthatlowbackpainwasthefifthmostcommonreasontoseeaphysician.4A2002NationalHealthInterviewSurveyindicatedthatonefourthofUSadultsreportedbackpaininthelast3−monthperiod.5A2006socioeconomicstudyshowedtotalcostsattributabletolowbackpainintheUnitedStateswereestimatedat100 billion, two-thirds of which were indirect costs of lost wages and productivity. 6 This quality measure addresses the percentage of adults between 18 and 65 years of age with back pain who were either counseled to remain active or referred to physical therapy. Maltreatment screening and action Maltreatment is a national priority. In children, maltreatment is associated with increased medical costs, approximating 9% of all Medicaid expenditures for children. 7 It is estimated that approximately 10% of older adults experience maltreatment or abuse. 8 Maltreatment of patients is reported at a higher frequency in patients with neurologic conditions that involve functional