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Weathers AL, Garg N, Lundgren KB, Benish SM, Baca CB, Benson RT. Improved Accuracy/Completeness of EHR Race/Ethnicity Data: A Requisite Step to Address Disparities in Care. Neurol Clin Pract 2024; 14:e200313. [PMID: 38720950 PMCID: PMC11073868 DOI: 10.1212/cpj.0000000000200313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/12/2024] [Indexed: 05/12/2024]
Abstract
Accurate and complete racial/ethnic data in the electronic health record are a requisite step to addressing disparities in neurologic care, and at local, regional, and national levels. The current data pertaining to the patients' race and ethnicity contained in the electronic health record are inadequate. This article outlines recommendations at the individual practice and electronic health record vendor level to improve documentation of race and ethnicity.
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Affiliation(s)
- Allison L Weathers
- Information Technology Division (ALW), Cleveland Clinic, Cleveland, OH; Department of Neurology (NG), University of California, Los Angeles; American Academy of Neurology (KBL); Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (CBB), Virginia Commonwealth University, Richmond, VA; and National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD
| | - Neeta Garg
- Information Technology Division (ALW), Cleveland Clinic, Cleveland, OH; Department of Neurology (NG), University of California, Los Angeles; American Academy of Neurology (KBL); Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (CBB), Virginia Commonwealth University, Richmond, VA; and National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD
| | - Karen B Lundgren
- Information Technology Division (ALW), Cleveland Clinic, Cleveland, OH; Department of Neurology (NG), University of California, Los Angeles; American Academy of Neurology (KBL); Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (CBB), Virginia Commonwealth University, Richmond, VA; and National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD
| | - Sarah M Benish
- Information Technology Division (ALW), Cleveland Clinic, Cleveland, OH; Department of Neurology (NG), University of California, Los Angeles; American Academy of Neurology (KBL); Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (CBB), Virginia Commonwealth University, Richmond, VA; and National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD
| | - Christine B Baca
- Information Technology Division (ALW), Cleveland Clinic, Cleveland, OH; Department of Neurology (NG), University of California, Los Angeles; American Academy of Neurology (KBL); Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (CBB), Virginia Commonwealth University, Richmond, VA; and National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD
| | - Richard T Benson
- Information Technology Division (ALW), Cleveland Clinic, Cleveland, OH; Department of Neurology (NG), University of California, Los Angeles; American Academy of Neurology (KBL); Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (CBB), Virginia Commonwealth University, Richmond, VA; and National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD
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Benson RT, Benish SM, Esper GJ, Kissela B, Rosendale N, Marulanda-Londono E, Hope OA, Pham TTA, Roe M, Torres A, Lien A, Kauwe S'K, Lundgren KB, Mante A, Schierman B, Jones LK. Measuring Ambulatory Racial and Ethnic Neurologic Disparities With the Axon Registry. Neurol Clin Pract 2023; 13:e200132. [PMID: 37064590 PMCID: PMC10101708 DOI: 10.1212/cpj.0000000000200132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/08/2022] [Indexed: 03/21/2023]
Abstract
Background and Objectives The primary objective is to examine potential racial and ethnic (R/E) disparities in ambulatory neurology quality measures within the American Academy of Neurology Axon Registry. R/E disparities in neurologic US morbidity and mortality have been clearly documented. Despite these findings, there have been no nationwide examinations of how ambulatory neurologic care affects these negative health outcomes. Methods This was a retrospective nonrandomized cohort study of patients in the AAN Axon Registry. The Axon Registry is a neurology-specific outpatient quality registry that collects, reports, and analyzes real-world deidentified electronic health record (EHR) data. Patients were included in the study if they contributed toward one of the selected quality measures for multiple sclerosis, epilepsy, Parkinson disease, or headache during the study period of January 1, 2019-December 31, 2019. Descriptive analyses of patient demographics were performed and then stratified by race and ethnicity. Results There were a total of 633,672 patients included in these analyses. Separate analyses were performed for race (64% White, 8% Black, 1% Asian, and 27% unknown) and ethnicity (52% not Hispanic, 5% Hispanic, and 43% unknown). The mean age ranged from 18 to 55 years, with 61% female and 39% male. Quality measures were chosen based on completeness of R/E data and were either process or outcomes focused. Statistically significant differences were noted after controlling for multiple comparisons. Discussion The large proportion of missing or unknown R/E data and low overall rate of performance on these quality measures made the relevance of small differences difficult to determine. This analysis demonstrates the feasibility of using the Axon Registry to assess neurologic disparities in outpatient care. More education and training are required on the accurate capture of R/E data in the EHR.
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Affiliation(s)
- Richard T Benson
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Sarah M Benish
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Gregory J Esper
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Brett Kissela
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Nicole Rosendale
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Erika Marulanda-Londono
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Omotola A Hope
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Tammy Thu Ann Pham
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Matthew Roe
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Aracelis Torres
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Amanda Lien
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Steven 'Ka'ai' Kauwe
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Karen B Lundgren
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Aristotle Mante
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Becky Schierman
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
| | - Lyell K Jones
- National Institute of Neurological Disorders and Stroke (RTB), NIH, Bethesda, MD; Department of Neurology (SMB), University of Minnesota, Minneapolis; Department of Neurology (GJE), Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (BK), University of Cincinnati, OH; Department of Neurology (NR), University of California, San Francisco; Department of Neurology (EM-L), University of Miami, FL; Department of Neurology (OAH), University of Texas, Houston; Department of Neurology (TTAP), Kaiser Permanente Colorado, Denver; Verana Health (MR, AT, AL, SKK), San Francisco, CA; American Academy of Neurology (KBL, AM, BS), Minneapolis, MN; and Department of Neurology (LKJ), Mayo Clinic, Rochester, MN
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Jones LK, McClean JC, Avitzur O. US Health Care System in 2035: The Neurology Future Forecasting Series. Neurology 2022; 98:402-408. [PMID: 35256518 DOI: 10.1212/wnl.0000000000200057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
Evolution of the US health care system has been punctuated by periods of rapid change. In the coming decades there will be meaningful and potentially disruptive developments in health care delivery mechanisms, the policy environment, and the populations for whom we provide care. Neurologists will need to adapt to changing patient expectations, market dynamics, and regulatory structures to thrive in the future health care environment. This article describes a forecast of potential changes in the US health care system by 2035, an assessment of the implications for the field of neurology, and a rationale for long-term strategic planning to prepare.
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Affiliation(s)
- Lyell K Jones
- From the Mayo Clinic (L.K.J.), Rochester, MN; San Antonio Military Medical Center (J.C.M.), TX; and American Academy of Neurology (O.A.), Tarrytown, NY.
| | - Jeffrey C McClean
- From the Mayo Clinic (L.K.J.), Rochester, MN; San Antonio Military Medical Center (J.C.M.), TX; and American Academy of Neurology (O.A.), Tarrytown, NY
| | - Orly Avitzur
- From the Mayo Clinic (L.K.J.), Rochester, MN; San Antonio Military Medical Center (J.C.M.), TX; and American Academy of Neurology (O.A.), Tarrytown, NY
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Wilson AM, Benish SM, McCarthy L, Romano JG, Lundgren KB, Byrne M, Schierman B, Jones LK. Quality of Neurologic Care in the United States: Initial Report From the Axon Registry. Neurology 2021; 97:e651-e659. [PMID: 34145002 DOI: 10.1212/wnl.0000000000012378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/14/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To provide the initial description of the quality of outpatient US neurologic care as collected and reported in the Axon Registry. METHODS We describe characteristics of registry participants and the performance of neurology providers on 20 of the 2019 Axon Registry quality measures. From the distribution of providers' scores on a quality measure, we calculate the median performance for each quality measure. We test for associations between quality measure performance, provider characteristics, and intrinsic measure parameters. RESULTS There were 948 neurology providers who contributed a total of 6,480 provider-metric observations. Overall, the average quality measure performance score at the provider level was 66 (median 77). At the measure level (n = 20), the average quality measure performance score was 53 (median 55) with a range of 2 to 100 (interquartile range 20-91). Measures with a lower-complexity category (e.g., discrete orders, singular concepts) or developed through the specialty's qualified clinical data registry pathway had higher performance distributions. There was no difference in performance between Merit-Based Incentive Payment System (MIPS) and non-MIPS providers. There was no association between quality measure performance and practice size, measure clinical topic/neurologic condition, or measure year of entry. CONCLUSIONS This cross-sectional assessment of quality measure performance in 2019 Axon Registry data demonstrates modest performance scores and considerable variability across measures and providers. More complex measures were associated with lower performance. These findings serve as a baseline assessment of quality of ambulatory neurologic care in the United States and provide insights into future measure design.
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Affiliation(s)
- Andrew M Wilson
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN.
| | - Sarah M Benish
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Lucas McCarthy
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Jose G Romano
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Karen B Lundgren
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Margaret Byrne
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Becky Schierman
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Lyell K Jones
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
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Patel AD. Measuring Quality of Epilepsy Care: The AAN Quality Measures. Pediatr Neurol 2021; 117:19-20. [PMID: 33647777 DOI: 10.1016/j.pediatrneurol.2020.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/22/2019] [Accepted: 01/05/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Anup D Patel
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
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Jones LK, Schwarz HB. Elasticity in Health Care: How Much Can We Stretch the System, and Our Patients? Neurology 2020; 96:87-88. [PMID: 33361252 DOI: 10.1212/wnl.0000000000011313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lyell K Jones
- From the Mayo Clinic (L.K.J.), Rochester, MN; and University of Rochester (H.B.S.), NY.
| | - Heidi B Schwarz
- From the Mayo Clinic (L.K.J.), Rochester, MN; and University of Rochester (H.B.S.), NY
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Patel AD, Herbst J, Gibson A, Karn M, Terry D, Debs A, Yarosz S, Parker W, Cohen DM. Using quality improvement to implement the CNS/AAN quality measure on rescue medication for seizures. Epilepsia 2020; 61:2712-2719. [PMID: 33063879 DOI: 10.1111/epi.16713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE A multidisciplinary quality improvement (QI) team was established to conduct analysis of data for prescribed seizure rescue medication doses from January 2013 to December 2015 to identify and improve inappropriately low dose prescriptions. The QI team identified areas of focus for improvement opportunities and developed the project objective based on the 2017 American Academy of Neurology (AAN) and Child Neurology Society (CNS) quality measure. METHODS Within a freestanding children's hospital, the QI team developed key drivers and implemented interventions, such as the midazolam prefilled syringe program with use of standardized dosing, electronic chart tools, monthly pharmacy review of all underdosed prescriptions, and provider and nursing education. The team created an automated monthly report to monitor prescribed seizure rescue medication dosing compliance. The year 2015 was used as the preliminary data baseline period with an average noncompliance rate of 3.5%. RESULTS From January 2016 to December 2019, the team has decreased and sustained the noncompliance rate to an average of 0.38%. The data for the project included 12,975 seizure rescue medication prescribed by a neurology provider from January 2015 to December 2019. Compliance with properly dosed diazepam orders continues to be the largest area of opportunity. The data demonstrated a centerline shift in January 2019, moving the baseline average of 7.2% noncompliance to the current average rate of 0.22%. In comparison, underdosed midazolam orders occurred at an average rate of 0.037% in the same timeframe. SIGNIFICANCE Using quality improvement methodologies, the team successfully and substantially decreased provider prescribed and signed underdosed rescue medication orders by an average of 89%. This QI project demonstrates successful implementation and improvement addressing the AAN/CNS quality measure of proper rescue seizure treatment dosing.
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Affiliation(s)
- Anup D Patel
- Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - James Herbst
- Department of Pharmacology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Annika Gibson
- Department of IS, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mary Karn
- Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Debbie Terry
- Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrea Debs
- Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Shannon Yarosz
- Department of Pharmacology, Nationwide Children's Hospital, Columbus, OH, USA
| | - William Parker
- Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel M Cohen
- Department of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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Jones LK. False economies in health care payment policy. Neurology 2020; 95:283-284. [DOI: 10.1212/wnl.0000000000010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Baca CM, Benish S, Videnovic A, Lundgren K, Magliocco B, Schierman B, Palmer L, Jones LK. Axon Registry® data validation. Neurology 2019; 92:847-858. [DOI: 10.1212/wnl.0000000000007404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/24/2019] [Indexed: 11/15/2022] Open
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10
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Affiliation(s)
- Lyell K Jones
- From the Mayo Clinic (L.K.J.), Rochester, MN; and Nationwide Children's Hospital and the Ohio State University (A.D.P.), Columbus
| | - Anup D Patel
- From the Mayo Clinic (L.K.J.), Rochester, MN; and Nationwide Children's Hospital and the Ohio State University (A.D.P.), Columbus.
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11
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Patel AD, Fritz JV, Evans DA, Lundgren KB, Hentges K, Jones LK. Utilizing the Axon Registry® for quality improvement. Neurol Clin Pract 2018; 8:456-461. [PMID: 30564501 DOI: 10.1212/cpj.0000000000000516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/11/2018] [Indexed: 11/15/2022]
Abstract
In 2015, the American Academy of Neurology began development of a clinical quality data registry now known as the Axon Registry®. The data collected by the Axon Registry and reported back to participants include performance on a number of quality measures relevant to neurology practice. While the Axon Registry may serve any number of needs for neurology practices, the essential function of the registry is to inform neurologists regarding the quality of their care and provide them with a tool to establish not only performance baselines but progress toward improved quality of care. This article includes 2 case studies of how the Axon Registry has been implemented in neurology practices to date. In the future, implementation of patient-reported outcome data and additional outcome measures will be necessary to expand the reach and effectiveness of the Axon Registry as a quality improvement tool.
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Affiliation(s)
- Anup D Patel
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - Joseph V Fritz
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - David A Evans
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - Karen B Lundgren
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - Katie Hentges
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
| | - Lyell K Jones
- Nationwide Children's Hospital (ADP), Columbus, OH; the Ohio State University College of Medicine (ADP), Columbus, OH; Dent Neurologic Institute (JVF), Amherst, NY; Texas Neurology (DAE), Dallas, TX; American Academy of Neurology (KBL, KH), Minneapolis, MN; and Mayo Clinic (LKJ), Rochester, MN
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12
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Eldh AC, Wallin L, Fredriksson M, Vengberg S, Winblad U, Halford C, Dahlström T. Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey. BMJ Open 2016; 6:e011562. [PMID: 28128099 PMCID: PMC5128910 DOI: 10.1136/bmjopen-2016-011562] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. METHODS Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. RESULTS A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with 'Colleagues' call for local results' (p=<0.001), 'Management Request of Registry data' (p=<0.001), and it was said to be 'Simple to explain the results to colleagues' (p=0.02). Using stepwise regression, 'Colleagues' call for local results' was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. CONCLUSIONS While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- School of Health and Social Science, Dalarna University, Falun, Sweden
| | - Lars Wallin
- School of Health and Social Science, Dalarna University, Falun, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sofie Vengberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Christina Halford
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tobias Dahlström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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13
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Affiliation(s)
- Neil A Busis
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; and Departments of Environmental and Occupational Health Sciences, Neurology, and Health Services (G.M.F.), University of Washington, Seattle.
| | - Gary M Franklin
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; and Departments of Environmental and Occupational Health Sciences, Neurology, and Health Services (G.M.F.), University of Washington, Seattle
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14
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Sigsbee B, Goldenberg JN, Bever CT, Schierman B, Jones LK. Introducing the Axon Registry: An opportunity to improve quality of neurologic care. Neurology 2016; 87:2254-2258. [PMID: 27694258 DOI: 10.1212/wnl.0000000000003264] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022] Open
Abstract
Clinical quality data registries are increasingly popular tools used by providers to improve the quality of clinical care and satisfy growing numbers of regulatory and reporting requirements. Specialty societies use registries to provide value to their members and guide improvements in care at the population level. In this article, we outline the rationale, structure, function, and challenges related to the American Academy of Neurology's development of its own clinical quality data registry: the Axon Registry.
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Affiliation(s)
- Bruce Sigsbee
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN.
| | - James N Goldenberg
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN
| | - Christopher T Bever
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN
| | - Becky Schierman
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN
| | - Lyell K Jones
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN
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15
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Jones LK, Raphaelson M, Becker A, Kaloides A, Scharf E. MACRA and the future of value-based care. Neurol Clin Pract 2016; 6:459-465. [PMID: 29443269 DOI: 10.1212/cpj.0000000000000296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The passage of Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 (MACRA) heralded a fundamental shift from volume-based to value-based payment for health care services in the United States. Beginning in 2019, neurologists will participate in 1 of 2 Medicare pathways: the Merit-Based Incentive Payment System or Alternative Payment Models. Both options represent an important change from the current fee-for-service payment models, and neurologists will need to be prepared well in advance of the MACRA launch. This article reviews the background, structure, uncertainties, and implications of MACRA on the practice of neurology, with recommendations for preparation.
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Affiliation(s)
- Lyell K Jones
- Department of Neurology (LKJ, ES), Mayo Clinic, Rochester, MN; private practice (MR), Leesburg, VA; and American Academy of Neurology (AB, AK), Minneapolis, MN
| | - Marc Raphaelson
- Department of Neurology (LKJ, ES), Mayo Clinic, Rochester, MN; private practice (MR), Leesburg, VA; and American Academy of Neurology (AB, AK), Minneapolis, MN
| | - Amanda Becker
- Department of Neurology (LKJ, ES), Mayo Clinic, Rochester, MN; private practice (MR), Leesburg, VA; and American Academy of Neurology (AB, AK), Minneapolis, MN
| | - Amy Kaloides
- Department of Neurology (LKJ, ES), Mayo Clinic, Rochester, MN; private practice (MR), Leesburg, VA; and American Academy of Neurology (AB, AK), Minneapolis, MN
| | - Eugene Scharf
- Department of Neurology (LKJ, ES), Mayo Clinic, Rochester, MN; private practice (MR), Leesburg, VA; and American Academy of Neurology (AB, AK), Minneapolis, MN
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16
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Affiliation(s)
- Gary M Franklin
- From the Departments of Environmental and Occupational Health Sciences, Neurology, and Health Services (G.M.F.), University of Washington, Seattle; and the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA.
| | - Neil A Busis
- From the Departments of Environmental and Occupational Health Sciences, Neurology, and Health Services (G.M.F.), University of Washington, Seattle; and the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA
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