 |
 |
The American Academy of Neurology has formulated a set of 10 quality measures for care of Parkinson's disease patients. The measures are designed to permit "evaluation of health care on its value, roughly defined as a ratio of quality to cost, and this is a step forward from evaluating health care solely on cost," according to the report. "Desirable physician-level measures address a gap in care, are evidence-based and linked to outcomes, are actionable, are feasible to collect, and have well-defined specifications." The 10 measures (and frequency of inquiry) are: 1. Annual Parkinson disease diagnosis review (at least annually) 2. Psychiatric disorders or disturbances assessment (at least annually) 3. Cognitive impairment or dysfunction assessment (at least annually) 4. Querying about symptoms of autonomic dysfunction (at least annually) 5. Querying about sleep disturbances (at least annually) 6. Querying about falls (every visit) 7. Parkinson disease rehabilitative therapy options (at least annually) 8. Parkinson disease-related safety issues counseling (at least annually) 9. Querying about Parkinson disease medication-related motor complications (every visit) 10. Parkinson disease medical and surgical treatment options reviewed (at least annually) Each measure statement "contains the denominator and numerator for each measure," the report explains. The denominator is the eligible patient population (in most cases, all patients with PD), and the numerator is the subset of patients who received the indicated delivery of care. Appropriate exclusions are provided in an appendix. For instance, for measure 5, "Querying about sleep disturbances," reads "All patients with a diagnosis of Parkinson disease (or caregivers, as appropriate) who were queried about sleep disturbances at least annually." In order to complete the measure, the physician would need to query the patient or caregiver about sleep disturbances at least annually, and document the discussion in the medical record. "Measuring the quality of health care is now central in the evaluation of health care plans for large corporations..., accreditation of hospitals by the Joint Commission, reimbursement of physicians through a pay-for-performance program run by Medicare, and maintenance of certification by specialty boards," the report states. "Once the clinician determines whether a patient is eligible, then the measure states how it is fulfilled.... The practice group can then implement a method to identify the patients and determine how to conduct the assessment....Note that these measures do not prescribe the use of specific medications, assessment tools, or treatment options. These measures leave clinicians with some flexibility within the evidence base in how the measures can be successfully completed." PD was chosen by the AAN as the prototype neurological condition for development of measures. The measures were developed by an expert panel through literature review of evidence-based and expert recommendations. Quality improvement in neurology: AAN Parkinson disease quality measures. Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology EM Cheng, S Tonn, R Swain-Eng, SA Factor, WJ Weiner, CT Bever, for the AAN PD Measure Development Panel Neurology 2010;75:2021-2027 Quality improvement in neurology: AAN Parkinson disease quality measures. Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology EM Cheng, S Tonn, R Swain-Eng, SA Factor, WJ Weiner, CT Bever, for the AAN PD Measure Development Panel Neurology 2010;75:2021-2027 ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn