Clinical Research Specialist Barrow Neurological Institute Glendale, Arizona
This abstract has been invited to present during the Better Patient Outcomes through Diversity Platform poster session
Background: The Epilepsy Learning Healthcare System (ELHS) aims to improve outcomes for patients with epilepsy by continuously innovating and applying new knowledge and best practices to epilepsy care. To help achieve this goal, ELHS developed a series of standardized outcome measures for both providers and patients.
Purpose: To establish a baseline for adherence to ELHS outcome measures by Barrow Neurological Institute (BNI) Epilepsy providers. Methods: Our research team developed an ELHS Chart Review Protocol (Table 1) to assess 19 outcome measures. A total of 130 charts were reviewed for 13 providers (ten charts per provider) including nine staff physicians, one nurse practitioner, and three fellows. All charts were selected from a 3-month period (November 2019 – January 2020). All charts were finalized and signed by their authors prior to review. Results: Cumulative scores for individual outcome measures can be viewed in the ELHS Chart Review Data Overview (Table 2).Overall, documentation of seizure types & frequency demonstrated the highest completion rates. However, many providers do not use ILAE Classifications and inconsistently assess seizure diary use.Mental Health & Women’s Health screening questions often had the lowest completion rates per provider and for all providers combined. Of note, patients who were non-verbal or had developmental delay were most often excluded from screening questions.Providers who used standardized templates in their charts completed ELHS outcome measures more often and more consistently. Templates were personalized to the preferences of each provider who utilized them.Providers who did not use templates or preferred “free-form” dictation completed ELHS outcome measures less often and less consistently.The time to review and assess individual charts depended on whether they utilized standardized templates. Charts utilizing templates could be reviewed in roughly half the time (approximately ten minutes per chart) compared to "free-form" charts (approximately 20 minutes per chart). Conclusions: The ELHS Chart Review is an effective and efficient tool for assessing baseline adherence to ELHS guidelines and determining which areas of focus could benefit from improved emphasis by both individual providers and as a division. ELHS has developed standardized case report forms which will allow continuous assessment of these outcome measures over time and their impact on patient care. Establishing the importance of specific outcome measures is essential to promoting consistent care of epilepsy patients over time and between individual providers or clinical sites nationally. This may lead to improved guidelines and better practices that will enable Epilepsy Centers nationwide to provide the best patient care. Limitations:
At the time of this chart review, ELHS measures were not mandatory. BNI providers were not required to use ELHS recommendations in their documentation.
Only a single visit per patient was reviewed over a three-month period. Many ELHS measures were meant to be evaluated over an entire year.
This review highlighted the need for creating special outcome measures for patients with developmental delay and/or verbal disability. Even when accompanied by a caretaker, mental health and women’s health screening questions were often not documented for these patients. In future reviews, these special outcome measures should be developed and assessed utilizing a separate protocol for this population.