Estas medidas para el Parkinson tienen por objetivo ayudar a los médicos a determinar cómo están siendo cuidados estos enfermos. Se han desarrollado 10 medidas diferentes para evaluar la atención de los pacientes de Parkinson, incluyendo síntomas no de motores, tales como la depresión o el sueño, que están fuertemente asociados con la calidad de vida. Otra de las medidas, mide el diagnóstico actual del paciente o el tratamiento, y también se incorporan otra medidas de seguridad, que incluye el asesoramiento sobre las complicaciones prevenibles, como son las caídas.
Las medidas de calidad deben ser cada vez más importantes para una mejor atención de las personas con trastornos neurológicos como el Parkinson. Sin embargo, ninguna de ellas puede determinar el uso de ciertos medicamentos, herramientas de evaluación u opciones de tratamiento.
Quality improvement in neurology: AAN Parkinson disease quality measures
Background: Measuring the quality of health care is a fundamental step toward improving health care and is increasingly used in pay-for-performance initiatives and maintenance of certification requirements. Measure development to date has focused on primary care and common conditions such as diabetes; thus, the number of measures that apply to neurologic care is limited. The American Academy of Neurology (AAN) identified the need for neurologists to develop measures of neurologic care and to establish a process to accomplish this.
Objective: To adapt and test the feasibility of a process for independent development by the AAN of measures for neurologic conditions for national measurement programs.
Methods: A process that has been used nationally for measure development was adapted for use by the AAN. Topics for measure development are chosen based upon national priorities, available evidence base from a systematic literature search, gaps in care, and the potential impact for quality improvement. A panel composed of subject matter and measure development methodology experts oversees the development of the measures. Recommendation statements and their corresponding level of evidence are reviewed and considered for development into draft candidate measures. The candidate measures are refined by the expert panel during a 30-day public comment period and by review by the American Medical Association for Current Procedural Terminology (CPT) II codes. All final AAN measures are approved by the AAN Board of Directors.
Results: Parkinson disease (PD) was chosen for measure development. A review of the medical literature identified 258 relevant recommendation statements. A 28-member panel approved 10 quality measures for PD that included full specifications and CPT II codes.
Conclusion: The AAN has adapted a measure development process that is suitable for national measurement programs and has demonstrated its capability to independently develop quality measures.
Health care stakeholders recognize the importance of measuring the quality of health care. Improvements in the quality of health care—such as the use of β-blockers after acute myocardial infarction1—have occurred shortly after programs to measure such care were implemented. Measuring the quality of health care is now central in the evaluation of health care plans for large corporations using Healthcare Effectiveness Data and Information Set measures,2 accreditation of hospitals by the Joint Commission,3 reimbursement of physicians through a pay-for-performance program run by Medicare,4,–,8 and maintenance of certification by specialty boards.9,10 Prior to measuring quality, the dominant measure of health care was cost. Measurement of quality permits evaluation of health care on its value, roughly defined as a ratio of quality to cost,11 and this is a step forward from evaluating health care solely on cost.
Programs that measure health care quality have focused on highly prevalent chronic conditions that are managed by primary care providers, such as asthma and diabetes, and have not focused on conditions treated by specialists. Although there is further work to be done in the science of measuring quality, there are consequences for delaying the development of quality measurement programs for specialty care. If the care delivered by specialists is not evaluated by these measurement programs, the value of health care delivered by specialists becomes difficult to quantify and can be underestimated. Furthermore, if the care delivered by specialists is measured by programs developed without the input of the specialists, the value of care may not be accurately measured.
Recognizing the potential impact of quality measurement on the practice of clinical neurology, the Board of Directors of the American Academy of Neurology (AAN) incorporated the development of quality measures (otherwise known as performance measures or quality indicators) for neurologic practice into their 2003 strategic plan12 and established the AAN Quality Measurement and Reporting (QMR) Subcommittee to carry out this task.13 A quality measure is a mechanism for assessing the degree to which a physician competently and safely delivers clinical services that are appropriate for the patient in the optimal time period.14,15 The measure specifications include a definition of the desired action or outcome and the patient population to whom the measure applies, which may include subpopulations that should be excluded. For example, a widely used quality measure is offering antiplatelet therapy to all patients presenting with acute ischemic stroke within 48 hours of hospital admission, excluding those patients who have contraindications to this therapy, such as active bleeding or allergies.16
In the past decade, the development of quality measures has been led by the American Medical Association (AMA)–convened Physician Consortium for Performance Improvement (PCPI), an organization consisting of over 170 representatives from key stakeholders such as medical specialty associations, including the AAN. The AAN was a lead organization in a PCPI activity to develop a set of quality measures for stroke and stroke rehabilitation,16 which is now part of Medicare's pay-for-reporting program.5 Because there is a backlog of measures to be developed by PCPI, the AAN developed a process to develop new quality measures independently or without the assistance of the PCPI. This report describes the development of quality measures for the care of PD, the first set of quality measures developed independently by the AAN.
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