Impact of Updates in Headache Quality Measures on Adherence to Best Practices in a Neurology Resident Clinic
Robert Cascella1, Christopher Anderson2, Enmanuel Perez1
1Department of Neurology, Washington University School of Medicine in St. Louis, 2Mayo Clinic - Arizona
Objective:
To assess the impact of a quality-improvement initiative on adherence to updated American Academy of Neurology (AAN) headache quality measures.
Background:
As an important resource for headache care, the AAN publishes quality measures, which were most recently updated in 2019. This single-site study at a large, academic tertiary referral center aimed to apply the AAN measures to its cohort of neurology resident physicians and evaluate adherence changes (primary outcome) as well as utilization of appropriate diagnostic criteria, patient education, and confidence in following AAN guidelines (secondary outcomes).
Design/Methods:
A pre-intervention (pre-QI) survey based on retrospective analysis of five clinic notes for adherence to the measures was designed and distributed to all neurology residents at our center. The intervention included creation of an electronic medical record template to aid residents in following the measures during clinical encounters as well as provision of direct feedback based on pre-QI results. Finally, a post-intervention (post-QI) survey was distributed for completion based on notes written during the intervention period. Significance testing of differences between pre- and post-QI values was performed using Chi-squared analysis. Analysis was limited to migraine headaches given a low percentage of cluster headaches seen in clinic.
Results:
An increase in adherence was seen in three of the four migraine-related quality measures, with two – utilization of migraine abortive therapies and counseling of modifiable lifestyle and chronification factors – showing significant improvement (p < 0.01). For secondary outcomes, increases in utilization of appropriate diagnostic criteria and patient education were both significant (p < 0.05), and a positive trend in self-assessed confidence rating for adherence to AAN guidelines was significant (p < 0.0001).
Conclusions:
This study provided evidence that our QI intervention led to increased adherence to the AAN migraine-related measures. It is anticipated that increased adherence may lead to improved patient outcomes.