December 1, 2010 — A 28-member expert panel of the American Academy of Neurology (AAN) has developed and published a set of 10 quality measures for the care of patients with Parkinson's disease (PD).
 

The new quality measures, developed by the AAN's Quality Measurement and Reporting Subcommittee and published November 30 in Neurology, are designed to help clinicians gauge how well they are caring for patients with the disease and make improvements where needed.
 

Six of the measures deal with assessing PD symptoms and 5 of these pertain to nonmotor symptoms, such as depression, sleep, and falls. Studies show "gaps in assessing nonmotor symptoms," the panel notes, "even though these are often strongly associated with quality of life." Three of the measures cover the patient's current diagnosis and treatment and 1 covers patient safety and counseling on preventable complications.
 

Reached for outside comment, David Charles, MD, chief medical officer, Vanderbilt Neuroscience Institute, Vanderbilt University Medical Center, Nashville, Tennessee, who was not involved in development of the tool, says it represents "a very important step forward in improving the quality of care for all people with Parkinson's disease.
 

"The authors and panel members are to be commended on an outstanding effort for creating this report and quality measurement instrument," he adds.
 

To develop the PD quality care measures, the panel followed guidelines established in 2003 by the AAN Quality Measurement and Reporting Subcommittee, which include topic selection, literature search, evaluation of the evidence base, drafting of the measures, discussion and public comment, and final approval by the AAN Board of Directors.
 

A review of the medical literature identified 258 relevant "recommendation statements" and the following 10 quality measures (titles and descriptions) were approved.
 

1. Annual Parkinson disease diagnosis review
 

All patients with a diagnosis of Parkinson disease who had their Parkinson disease diagnosis reviewed, including a review of current medications and a review for the presence of atypical features (eg, falls at presentation and early in the disease course, poor response to levodopa, symmetry at onset, rapid progression [to Hoehn & Yahr stage 3 in 3 years], lack of tremor or dysautonomia) at least annually.
 

2. Psychiatric disorders or disturbances assessment
 

All patients with a diagnosis of Parkinson disease who were assessed for psychiatric disorders or disturbances (eg, psychosis, depression, anxiety disorder, apathy, or impulse control disorder) at least annually.
 

3. Cognitive impairment or dysfunction assessment
 

All patients with a diagnosis of Parkinson disease who were assessed for cognitive impairment or dysfunction at least annually.
 

4. Querying about symptoms of autonomic dysfunction
 

All patients with a diagnosis of Parkinson disease (or caregivers, as appropriate) who were queried about symptoms of autonomic dysfunction (eg, orthostatic hypotension, constipation, urinary urgency/incontinence and fecal incontinence, urinary retention requiring catheterization, or persistent erectile failure) at least annually.
 

5. Querying about sleep disturbances
 

All patients with a diagnosis of Parkinson disease (or caregivers, as appropriate) who were queried about sleep disturbances at least annually.
 

6. Querying about falls
 

All visits for patients with a diagnosis of Parkinson disease where patients (or caregivers, as appropriate) were queried about falls.
 

7. Parkinson disease rehabilitative therapy options
 

All patients with a diagnosis of Parkinson disease (or caregivers, as appropriate) who had rehabilitative therapy options (eg, physical, occupational, or speech therapy) discussed at least annually.
 

8. Parkinson disease–related safety issues counseling
 

All patients with a diagnosis of Parkinson disease (or caregivers, as appropriate) who were counseled about context-specific safety issues appropriate to the patient's stage of disease (eg, injury prevention, medication management, or driving) at least annually.
 

9. Querying about Parkinson disease medication–related motor complications
 

All visits for patients with a diagnosis of Parkinson disease where patients (or caregivers, as appropriate) were queried about Parkinson disease medication–related motor complications (eg, wearing off, dyskinesia, or off-time).
 

10. Parkinson disease medical and surgical treatment options reviewed
 

All patients with a diagnosis of Parkinson disease (or caregivers, as appropriate) who had the Parkinson disease treatment options (eg, nonpharmacologic treatment, pharmacologic treatment, or surgical treatment) reviewed at least once annually.
 

In a statement from AAN, lead author Eric M. Cheng, MD, MS, of the David Geffen School of Medicine at University of California, Los Angeles, said, "Measuring the quality of health care is a fundamental step toward improving health care, and many quality measurement efforts are under way. The American Academy of Neurology is taking a leading role in ensuring that the quality of care for people with neurologic disorders is included in these efforts.
 

"Quality measures like these will be increasingly important for extending the best care possible to people with neurologic disorders like Parkinson's disease," Dr. Cheng said.
 

The AAN is working on developing similar quality care measures for epilepsy, stroke, dementia, neuropathy, headache, and multiple sclerosis.
 

文献来源
Megan Brooks.New AAN Tool Defines Topnotch Parkinson's Disease Care.Neurology. 2010;75:2021-2027.