Epilepsy Quality Performance Over Time: A National Veterans Health Administration Quality Improvement Study
Hamada Altalib1, Margaret Gopaul2, Sharyl Martini3, Mary Jo Pugh4
1VA Connecticut Healthcare System, 2Neurology, Yale University, 3VHA Neurology, 4VA Salt Lake City Health Care System
Objective:
This study explores trends in epilepsy related quality performance measures (EQM) over time across the Veterans Healthcare System (VA) nationally.
Background:
As the largest integrated healthcare system in the U.S., the VA offers an opportunity to compare epilepsy care across many different regions and levels of service complexity. An Epilepsy Centers of Excellence service was deployed between 2010-2012. This study explores the changes in epilepsy care over time at a national level.
Design/Methods:
Data from a retrospective cohort study conducted from 2008-2014 was merged with a quality improvement (QI) study conducted in 2022 within the VA. EQM based on American Academy of Neurology guidelines were abstracted from newly diagnosed and chronically followed patients with ICD 9 or 10 diagnoses of epilepsy. Five to 50 patients were randomly sampled across VA facilities. For those sampled, epilepsy related clinical encounters during 2009, 2012, 2014, and 2022 were evaluated. The proportion of EQM documented for each encounter was averaged for individual facilities with at least 25 patients sampled. Facilities with advanced resources (Epilepsy Centers of Excellence [ECOE]) were compared to affiliated (Consortium) and unaffiliated facilities.
Results:
Of the 5,876 patients from 73 facilities, 626 (10.65%) were women, and 536 (9.12%) were newly diagnosed with epilepsy. EQM related to diagnostic work-up, such as ordering neuroimaging and electroencephalograph for new-onset seizures, remained stable over time (with average facility meeting EQM ranging from 52% to 82.9%). In prior years, counseling patients about safety, seizure triggers, and adverse events occurred <20% of encounters, and in 2022, improved to 24.7-64.4%.
Conclusions:
Nationally, neurologists are better at documenting diagnostic work-up and seizure diagnosis, which was stable over time. In general, neurologists poorly documented counseling and education; however, there was a significant improvement over time. ECOEs tend to perform better.