Epilepsy Quality Measures To Improve Performance (EQUIP): A Practical 10-Point Score For Assessing Epilepsy Quality Measures In Routine Clinical Practice.
sohail dewain1, Saifeldin Hossameldin1, Nuthalapati Poojith2, Margaret Gopaul3, Abigail Herbst4, Bridget Gaglio4, Priyanka Deep5, Kelly Fischbein5, Hamada H. Altalib3
1neurology, yale university, 2neurology, yale university/ VA Connecticut healthcare system, 3yale university/ VA Connecticut healthcare system, 4PPD Evidera Patient-Centered Research, 5UCB Pharma
Objective:
To evaluate the use and documentation of the EQUIP measures in routine clinical practice
Background:
Epilepsy quality measures (EQM) established by the American Academy of Neurology (AAN-EQM) and National Association of Epilepsy Centers (NAEC) outpatient measures aim to improve care quality, yet their adoption in routine clinical practice remains limited. Several measures have been retired due to challenges in obtaining data from unstructured clinical notes. We reviewed AAN, NAEC, and Quality Indicators in Epilepsy Treatment (QUIET) guidelines (including retired measures) and selected specific measures to create the EQUIP measures—a shorter, structured, measurable, and scalable 10-point score.
Design/Methods:
We prospectively reviewed 232 outpatient epilepsy encounters at Yale Epilepsy Center (November 2024 to October 2025). EQUIP score includes 10 primary quality measures across four domains: seizure metrics (frequency, type, etiology, date of last seizure, severe seizures, status epilepticus and seizure clusters), treatment (medication adherence), comorbidity (behavioral health screening), and counseling/education (driving/safety, lifestyle/trigger counseling), plus reproductive health counseling for childbearing age women. Each measure was scored using a binary system (1 point per completed measure), calculated as (completed measures/total applicable measures) × 100%.
Results:
Among 232 participants (mean age 46.35 years, 48.7% [n=113] female, 70% [n=162] Caucasian, 40% [n=91] unemployed), the cohort was stratified by applicable measures: males and non-childbearing women (78.6%, n=176) and childbearing potential females (21.4%, n=48). Mean overall EQUIP scores were 7.27 (SD=1.45) and 7.29 (SD=2.4) respectively. Seizure-specific assessments (mean: 4.48 and 4.40, SD: 0.87 and 0.96) and treatment measures (mean: 1.54, and 1.46, SD: 0.63 and 0.74) were highly documented, while comorbidity measures (mean: 0.39 and 0.33, SD: 0.49 and 0.48) and education/counseling measures (mean: 0.89 and 1.1, SD: 0.86 and 1.12) were less documented.
Conclusions:
We demonstrated the use of the EQUIP quality measurement score in routine clinical practice. Feasibility data are being collected through semi-structured qualitative interviews to further inform implementation.
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