Quality improvement in neurology: AAN Parkinson disease quality measures

Cheng, Eric M.; Tonn, S.; Swain-Eng, Rebecca J.; Factor, Stewart A.; Weiner, W. J.; Bever, C. T.

doi:10.1212/wnl.0b013e3181ff96dd

Cited by 106 publications

(55 citation statements)

References 23 publications

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“…2 The American Academy of Neurology (AAN) quality improvement guidelines recommend that neuropsychiatric symptoms should be assessed annually in all patients with PD. 3 When neuropsychiatric symptoms are observed, it is important to attempt to uncover the cause of these symptoms as they may be situational, medication related, the result of other medical conditions, intrinsic to PD or a combination of these factors.…”

Section: Supportmentioning

confidence: 99%

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

Pahwa¹,

Lyons²

2016

US Neurology

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N europsychiatric symptoms, such as psychosis, are well described in Parkinson's disease (PD); most appear to be due to disease pathology with exacerbation caused by dopaminergic treatment. More than 50% of patients with PD develop psychosis at some point throughout their disease course. Clinicians need to routinely assess patients with PD for psychotic symptoms, particularly hallucinations. Treatment of psychotic symptoms in PD is an unmet need as there are currently no US Food and Drug Administration (FDA) approved medications specifically for PD psychosis (PDP). Current treatments for PDP have been adapted from dopamine antagonists used to treat psychosis in other conditions, such as schizophrenia. Typical antipsychotics, as well as some atypical antipsychotics, worsen PD motor symptoms due to blockade of dopamine D2 receptors. Quetiapine and clozapine have been studied in PDP and are the most commonly used treatments for PDP. Clozapine has been shown to be effective; however, regular bloodwork is required, while data for quetiapine are inconsistent. Pimavanserin, a highly selective serotonin (5HT2A subtype) receptor inverse agonist, is not associated with motor worsening in PDP patients due to the absence of dopamine blockade. In a double-blind, placebo-controlled study, pimavanserin showed significant improvement in moderate to severe psychosis compared to placebo, with good tolerability and without worsening of PD motor symptoms. These data suggest that pimavanserin is a safe and efficacious treatment for PDP psychosis and could be a potential new treatment option for PDP.

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Section: Supportmentioning

confidence: 99%

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

Pahwa¹,

Lyons²

2016

US Neurology

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“…It is doubtful, for example, that many primary care physicians are aware of or follow clinical guidelines for PD care published by the American Academy of Neurology. 32 Studies suggest that neurologist care in the management of PD improves outcomes. Using Medicare data to identify patients with PD, we found that only 40% of prevalent PD patients saw a neurologist over a 4-year period.…”

Section: Approaches To Maximize Functionmentioning

confidence: 99%

Time to change the blind men and the elephant approach to Parkinson disease?

Racette

Willis

2015

Neurology

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Time to change the blind men and the elephant approach to Parkinson disease? ABSTRACTParkinson disease (PD) is a progressive neurodegenerative disease that is associated with substantial morbidity and early mortality. Disease-related costs exceed $10 billion, not including medications, out-of-pocket expenses, or societal costs. Symptomatic treatment with levodopa, which has been available for over 30 years, and advanced therapies such as deep brain stimulation improve outcomes. Yet most new medications for PD provide a therapeutic benefit that is relatively modest compared to the benefits from levodopa. Despite dozens of neuroprotective clinical trials, there are no medications proven to slow the progression of the disease. Given these limitations, we provide evidence of the potential public health impact of a research agenda that emphasizes identification of risk factors to reduce disease burden through exposure mitigation. In addition, we emphasize health care policy that focuses on increasing health care expenditures for neurologic evaluation and management services to increase access to specialists to improve disease outcomes and reduce costs through better disease management. Neurology ® 2015;85:190-196 GLOSSARY AOR 5 adjusted odds ratio; CI 5 confidence interval; CMS 5 Centers for Medicare and Medicaid Services; E&M 5 evaluation and management; OR 5 odds ratio; PAR 5 population attributable risk; PD 5 Parkinson disease; tPA 5 tissue plasminogen activator; UPDRS 5 Unified Parkinson's Disease Rating Scale.In the story "Elephant and the blind men," 1 6 blind men discover a creature (an elephant) in their village that they have never encountered. They touch the various parts of the elephant and describe the elephant as a pillar, rope, tree trunk, wall, and tree branch. They argue bitterly until a wise man tells them all of their analyses are accurate, but incomplete. A common interpretation of that story is that without the big picture, one can easily come to a false conclusion. In many ways, the current research approach to Parkinson disease (PD) is similar to the "Elephant and the blind men." We have made substantial advances in understanding PD, but the big picture eludes us. In the following paragraphs, we argue that we have the potential to reduce PD burden and morbidity considerably by shifting to the clinical and research approach used in stroke, namely a public health approach that focuses providing access to the most effective treatments without disparity and prioritizing primary prevention and health outcomes research.The National Institutes for Neurologic Disease and Stroke recently announced the failure of the .$60 million NIH Exploratory Trials in Parkinson's Disease trial of creatine to demonstrate efficacy in slowing PD progression. This joins a long list of failed disease-modifying PD trials, including selegiline, 2,3 riluzole, CEP-1347, 4 rasagiline, 5 creatine, 6 and cell-based therapies. 7,8 Possible explanations for these disappointments include disease models that do not replicate neuro...

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“…We describe our methodology in previous publications. 14 from the AAN guideline subcommittees to perform systematic reviews of the literature and to identify efficacious processes of neurologic care. Yet it is also clear that QMR and the AAN need to better inform AAN members about PQRS and other similar quality measurement programs.…”

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confidence: 99%

Quality measurement

2014

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SummaryThe Centers for Medicare and Medicaid Services (CMS) is shifting from volume-based to value-based reimbursement of health care services. Measuring the value of health care requires measurement of quality and cost. We provide an overview of quality measurement and review a well-known and widely used conceptual model for assessing quality: structure, process, and outcome. We highlight the advantages and disadvantages of using these types of metrics. We then use this conceptual model to describe prominent CMS programs such as the Physician Quality Reporting System, Physician Compare Web site, and the Medicare Shared Savings Plan. We highlight 2 recent trends: the increasing use of outcome measures to supplement process measures and the public reporting of quality. P roposed over 40 years ago, Dr. Avedis Donabedian's 1 conceptual model of health care remains useful today. A strength of this model is that it provides a common language for describing how to measure quality. Dr. Donabedian divided health care into 3 dimensions: outcomes, processes, and structure. Outcomes of care are what happen to patients. Processes of care are the actions that clinicians perform on behalf of patients to produce better outcomes. Structures of care are characteristics that change how likely a process of care will occur. We review each dimension in turn, underscoring the advantages and disadvantages of each, to create a foundation for analyzing the goals of current and future quality measurement programs.

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Quality improvement in neurology: AAN Parkinson disease quality measures

Abstract: Background: Measuring the quality of health care is a fundamental step toward improving health

Cited by 106 publications

References 23 publications

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

Time to change the blind men and the elephant approach to Parkinson disease?

Quality measurement

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