Development of Performance Indicators for the Primary Care Management of Pediatric Epilepsy: Expert Consensus Recommendations Based on the Available Evidence

Department of Pediatrics, Division of General Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
Epilepsia (Impact Factor: 4.57). 01/2007; 47(12):2011-9. DOI: 10.1111/j.1528-1167.2006.00853.x
Source: PubMed


To use available evidence and expert consensus to develop performance indicators for the evaluation and management of pediatric epilepsy.
We used a three-step process to develop the performance indicators. First, research findings were compiled into evidence tables focusing on different clinical issues. Second, an advisory panel of clinicians, educational and public health experts, and families of children with epilepsy reviewed the evidence. The advisory group used the evidence to draft a preliminary set of performance indicators for pediatric epilepsy management. Third, 13 internationally recognized experts in pediatric neurology or epilepsy rated the value of these indicators on a 5-point scale [1 (essential) to 5 (not necessary)] in a two-round Delphi process. Positive consensus was reached if >or=80% of experts gave an indicator a "1" rating and negative consensus if >80% gave an indicator a "5" rating. Indicators that achieved positive consensus during either round of the Delphi process constituted the final set of indicators.
Of the 68 draft performance indicators, the expert panel members achieved positive consensus on 30 performance indicators: eight indicators related to diagnostic strategies and seizure classification, nine related to antiepileptic drug use, six related to cognitive and behavioral issues, six related to quality of life, and three related to specialty referrals.
We identified 30 potential indicators for evaluating the care provided to pediatric patients with epilepsy. The next step is to examine the relation of these performance indicators to clinical outcomes and health care utilization among pediatric patients with epilepsy.

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Available from: Jaya K Rao, Oct 04, 2015
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    • "Future research should examine whether expansion of care guidelines would affect stigma and overall perceptions of care, especially in those developing epilepsy at younger ages. In fact, similar recommendations for research evaluating pediatric epilepsy care, including addressing stigma when educating patients, were made as a result of an expert consensus group [35]. DiIorio and colleagues' studies have identified and commenced the process of developing evidence-based interventions for selfmanagement to increase self-efficacy and decrease stigma [7– 9,14,15,20,21]. "
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    ABSTRACT: Living Well with Epilepsy II called for further attention to stigma and its impact on people with epilepsy. In response, the South Carolina Health Outcomes Project on Epilepsy (SC HOPE) is examining the relationship between socioeconomic status, epilepsy severity, health care utilization, and quality of life in persons diagnosed with epilepsy. The current analysis quantifies perceived stigma reported by adults with epilepsy in relation to demographic, seizure-related, health, and psychosocial factors. It was found that reported levels of stigma were associated with interactions of seizure worry and employment status, self-efficacy and social support, and quality care and age at seizure onset. This information may be used to target and develop evidence-based interventions for adults with epilepsy at high risk for perceived stigma, as well as to inform epilepsy research in self-management.
    Epilepsy & Behavior 11/2009; 16(3-16):484-490. DOI:10.1016/j.yebeh.2009.08.028 · 2.26 Impact Factor
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    ABSTRACT: Objective To work out a system of indicators for improvement of primary care prescription, by incorporating the values and views of the professionals issuing prescriptions. Design Qualitative technique to search for consensus among experts, based on nominal groups. Setting All primary care areas in the Health Service of Aragon, Spain. Participants Primary care doctors, doctors in primary care management teams, specialists, primary care pharmacists. Method Two parallel groups involving a total of 24 experts were formed. In the session these questions were posed: “what indicators focusing on the drug and what indicators relating diagnosis and treatment do you think most useful for evaluating prescription quality?” Each panellist put forward indicators that were then discussed and placed on a scale of 1 to 9. Results One hundred and thirty six indicators were generated, 81 drug-focused and 55 relating diagnosis and treatment; 56% were given a weighting above 5. The 2 groups coincided in 11 cases. The most valued indicators were generally those that brought a greater degree of consensus. Conclusion It is feasible, through this technique, to produce a set of agreed indicators for evaluating primary care doctors’ prescription.
    Atención Primaria 06/2006; 38(1):39-44. DOI:10.1157/13090031 · 0.95 Impact Factor
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    ABSTRACT: To evaluate drug-related problems in the elderly, various lists of potentially inappropriate medications have been published in North America. Unfortunately, these lists are hardly applicable in France. The purpose of this study was to establish a list of inappropriate medications for French elderly using the Delphi method. A two-round Delphi method was used to converge to an agreement between a pool of 15 experts from various parts of France and from different backgrounds (five geriatricians, five pharmacologists, two pharmacists, two general practitioners, one pharmacoepidemiologist). In round one, they were sent a questionnaire based on a literature review listing medications and clinical situations. They were asked to comment on the potential inappropriateness of the criteria proposed using a 5-point Likert scale (from strong agreement to strong disagreement) and to suggest therapeutic alternatives and new criteria. In round two, the experts confirmed or cancelled their previous answers from the synthesis of the responses of round one. After round two, a final list of potentially inappropriate drugs was established. The final list proposed 36 criteria applicable to people >/=75 years of age. Twenty-nine medications or medication classes applied to all patients, and five criteria involved medications that should be avoided in specific medical conditions. Twenty-five medications or medication classes were considered with an unfavourable benefit/risk ratio, one with a questionable efficacy and eight with both unfavourable benefit/risk ratio and questionable efficacy. This expert consensus should provide prescribers with an epidemiological tool, a guideline and a list of alternative therapies.
    European Journal of Clinical Pharmacology 08/2007; 63(8):725-31. DOI:10.1007/s00228-007-0324-2 · 2.97 Impact Factor
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