Quality measures have been developed for many different frameworks of medical care to address structures, processes, and/or outcomes. They also address important components of healthcare quality, including patient safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. Performance metrics and quality measures are increasingly becoming important for measuring progress and determining reimbursement for physicians and other providers.
“When these measures are utilized in their entirety, they provide a framework for uniform quality and assessment of the many facetsand presentations of PD.”
The American Academy of Neurology (AAN) established its own measures to improve the quality of treatment provided for Parkinson’s disease (PD) and to better understand how to improve quality of life in this patient group. In the November 30, 2010 issue of Neurology, my colleagues and I published a set of 10 quality measures for the care of patients with PD that were endorsed by the AAN. These measures are the result of a collaboration of a 28-person expert panel. Each measure identifies the patient population eligible for the measure—all patients with a diagnosis of PD—and identifies the temporal application. Once clinicians determine whether patients are eligible, then the measure states how it’s fulfilled. Clinicians managing patients with PD can then implement strategies to identify appropriate candidates and determine how to conduct assessments.
Summarizing Quality Measures for Parkinson’s Disease
Six of the measures address the assessment of PD symptoms, three cover the current diagnosis and treatment, and one covers patient safety and counseling on preventable complications. The first quality measure for PD is that all patients with the disease have their diagnosis and current medications reviewed at least annually, including a review of the presence of atypical features. Patients with PD should also be assessed at least once a year for the following conditions:
– Psychiatric disorders or disturbances.
– Cognitive impairment or dysfunction.
– Symptoms of autonomic dysfunction.
– Sleep disturbances.
The quality measures also recommend that physicians discuss with all patients with PD—and their caregivers, when appropriate—rehabilitative therapy options, such as physical, occupational, or speech therapy. Counseling on PD-related safety issues should also be provided annually, and may include information on injury prevention, medication management, or driving. A discussion of PD medication-related motor complications, including wearing off, dyskinesia, or off-time, should also take place during all visits with patients with PD. Lastly, non-pharmacologic, pharmacologic, and surgical treatment options should be reviewed with patients at least once a year.
A Strong Framework to Guide Treatment
When these measures are utilized in their entirety, they provide a framework for uniform quality and assessment of the many facets and presentations of PD. Providing a clearer understanding of disease management protocols for patients based on their experience with PD may help guide treatment decisions. Importantly, following these measures may ensure that disease-related experiences can be addressed so that quality-of-life issues aren’t overlooked. With regard to motor dysfunction, the AAN measures help physicians frame specific questions to ask so that they comprehensively assess functional ability.
Quality measures like these will be increasingly important for extending the best care possible to people with neurologic disorders like PD. With the 10 quality measures for PD, the AAN has established an ability to independently develop an evidence-based approach for the management of neurological diseases, and plans are underway to continue these efforts. The AAN is working on developing similar quality care measures for epilepsy, stroke, dementia, neuropathy, headache, and multiple sclerosis.
Cheng EM, Tonn S, Swain-Eng R, et al. Quality improvement in neurology: AAN Parkinson disease quality measures. Neurology. 2010;75:2021-2027. Available at:http://www.neurology.org/content/75/22/2021.full.pdf+html.
Goetz CG, Koller WC, Poewe W, et al. Management of Parkinson’s disease: an evidence-based review.Mov Disord. 2002;17(suppl 4):S1-S166.
Cheng EM, Siderowf A, Swarztrauber K, et al. Development of quality of care indicators for Parkinson’s disease. Mov Disord. 2004;19:136-150.
Zesiewicz TA, Sullivan KL, Arnulf I, et al. Practice parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:924-931.