Implementation of a Web-Based Real-Time Quality Metric Tool to Improve Provider Practices in an Epilepsy Clinic: NeuroMeasures(TM)

Background and Objectives: The retrospective nature of most available epilepsy quality improvement tools focus on changing healthcare provider clinical habits and documentation practices rather than a focus on real-time patient interventions. Furthermore, patient-reported outcome data is often not available to determine the efficacy of these tools. Our primary objective was to demonstrate improvement of healthcare providers’ documentation and review of epilepsy quality measures during the patient visit with the implementation of a novel web application, NeuroMeasures™. Our secondary objective was to improve the percentage of point-of-care counselling and interventions based on quality measures during the patient encounter based on the results of the NeuroMeasures^TM tool.

Methods: Our quality improvement study focused on comparing a pre- and post-intervention cohort of epilepsy patients prior to the implementation of NeuroMeasures™, a web-based application which takes a self-guided patient survey through self-scoring algorithms focused on the American Academy of Neurology’s 2017 Epilepsy Quality Measures (EQMs). This e-tool then provides the healthcare provider (HCP) a tool to directly review the EQMs highlighted and perform any necessary counselling or interventions at the point-of-care visit. Post-intervention EQMS were gained from review of the NeuroMeasures™ HCP quality measures tool as well as a chart review for physician documentation. Patients with language barriers and severe cognitive disabilities were excluded from the study.

Results: The pre-intervention cohort consisted of 150 unique epilepsy patients and the post-intervention included 379 unique adult epilepsy patients and 515 total encounters. Overall percentages of review/adherence of EQMS were significantly improved between the pre and post-intervention group for: counseling for women of childbearing potential (91.7%), intractable epilepsy referral to a comprehensive epilepsy center (74%), quality of life assessment (80%), improvement of quality-of-life measurements (41.7%), and depression and anxiety screening (85.6%), demonstrating a significant increase when compared to the pre-intervention group (p < 0.00001).

Discussion: A web-based, point-of-care epilepsy quality measures application demonstrated significant improvement of the HCP’s ability to perform and review EQMs at the point-of-care patient visit. Furthermore, the application was successful in creating opportunities for direct intervention based on the EQMS and chances for better patient education and provider-patient communication. Further considerations would include automated survey requests and expansion into other AAN QMs.