Quality improvement in neurology: AAN Parkinson disease quality measures: Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology

Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA.
Neurology (Impact Factor: 8.29). 11/2010; 75(22):2021-7. DOI: 10.1212/WNL.0b013e3181ff96dd
Source: PubMed


Measuring the quality of health care is a fundamental step toward improving health care and is increasingly used in pay-for-performance initiatives and maintenance of certification requirements. Measure development to date has focused on primary care and common conditions such as diabetes; thus, the number of measures that apply to neurologic care is limited. The American Academy of Neurology (AAN) identified the need for neurologists to develop measures of neurologic care and to establish a process to accomplish this.
To adapt and test the feasibility of a process for independent development by the AAN of measures for neurologic conditions for national measurement programs.
A process that has been used nationally for measure development was adapted for use by the AAN. Topics for measure development are chosen based upon national priorities, available evidence base from a systematic literature search, gaps in care, and the potential impact for quality improvement. A panel composed of subject matter and measure development methodology experts oversees the development of the measures. Recommendation statements and their corresponding level of evidence are reviewed and considered for development into draft candidate measures. The candidate measures are refined by the expert panel during a 30-day public comment period and by review by the American Medical Association for Current Procedural Terminology (CPT) II codes. All final AAN measures are approved by the AAN Board of Directors.
Parkinson disease (PD) was chosen for measure development. A review of the medical literature identified 258 relevant recommendation statements. A 28-member panel approved 10 quality measures for PD that included full specifications and CPT II codes.
The AAN has adapted a measure development process that is suitable for national measurement programs and has demonstrated its capability to independently develop quality measures.

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Available from: Christopher T Bever, Nov 12, 2014
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    • "Though it is possible that some items could have been classified into alternate categories, this does not dilute the overall message that psychosocial issues are dominant in the minds of our participants. Though psychosocial issues related to coping with PD have been recognized by some investigators as contributors to reduced quality of life in PD [26, 27], healthcare provider focus is generally on symptom management and medication adjustment as reflected in professional guidelines [28]. PD guidelines do not explicitly address psychosocial issues. "
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    ABSTRACT: Background. Parkinson's disease (PD) is a neurodegenerative condition with complex subtleties, making it challenging for physicians to fully inform their patients. Given that approximately 50% of Americans access the Internet for health information, the development of a multimedia, web-based application emphasizing targeted needs of people with Parkinson's disease (PwP) has the potential to change patient's lives. Objectives. To determine what information PwP perceive could enhance their quality of life. Methods. Group sessions utilizing nominal group technique (NGT) were conducted. Participants were asked “what information do you want to know about that would help you live well with PD?” Silent generation of ideas preceded discussion followed by anonymous ranking of items. A “summary score” (sum of rank × frequency) was calculated. Results. 36 individual items were collapsed into 9 categories. Coping with emotions, changing relationships, and social implications of PD were ranked as most important. Financial supports and skills for self-advocacy were also highly ranked. Conclusions. Qualitative research methodology was utilized to determine the unmet needs of PwP. Results of this survey will inform the development of a patient-oriented, online resource, the goal will be to provide information and strategies to improve symptom management, reduce disability and address all relevant concerns important to those affected by PD.
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