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. 2019 Jun;9(3):187-193.
doi: 10.1212/CPJ.0000000000000614.

Minding the gap in pediatric headache care: Can a focus on quality measures improve outcomes?

Scott Turner  1 , Amanda Foss-Barratt  1 , Jessica Malmberg  1 , Jennifer Disabato  1
Affiliations

Minding the gap in pediatric headache care: Can a focus on quality measures improve outcomes?

Scott Turner et al. Neurol Clin Pract. 2019 Jun.

Abstract

Background: The American Academy of Neurology Headache Quality Measures seek to improve care delivery and outcomes by addressing gaps in care. Our practice identified underperformance in 3 of the 7 measures that apply to children and adolescents. We expected that improved performance on these measures would lead to a reduction in emergency department (ED) visits and improvement in the average disability grade of established patients.

Methods: An interdisciplinary workgroup used the Institute for Healthcare Improvement's Model for Improvement. Quality improvement (QI) interventions focused on the use of Pediatric Migraine Disability Assessment (PedMIDAS), headache action plans (HAPs), nurse triage, and infusion center order sets.

Results: Provider use of PedMIDAS increased from 15% to 55% (p <0 .0001) of patient visits during the comparison period. Generation of HAP letters increased from 10% to 15% (p < 0.0003), but these gains were not sustained. ED visits for headache decreased by 32% (p < 0.0001). The average migraine disability grade remained unchanged.

Conclusions: QI efforts using team-based strategies and electronic medical record (EMR) integration can improve performance on headache quality measures, although it may be difficult to demonstrate improved patient outcomes. The project's time frame and disability assessment strategy were likely insufficient to detect a change in disability. Optimization of nurse triage and EMR workflows enabled more patients with status migrainosus to receive their treatment in the infusion center rather than the ED with a favorable revenue benefit for the hospital.

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Figures

Figure 1
Figure 1. Percent of patients with PedMIDAS collected at visit, P chart
Control chart showing the percent of patients with headache who completed a PedMIDAS by month. Control charts use upper and lower control limits set at 3 SDs from the mean to determine when a process has departed from its historical pattern of variability. Avg = average; LCL = lower control limit; UCL = upper control limit.
Figure 2
Figure 2. Percent of patients receiving headache action plan letter at visit, P chart
Control chart showing the percent of clinic patients with a headache diagnosis who received an action plan letter at their visit by month. Avg = average; ED = emergency department; EMR = electronic medical record; LCL = lower control limit; UCL = upper control limit.
Figure 3
Figure 3. Number of ED events per established patient, U chart
Control chart showing the number of ED visits (events) per established headache patient (unit) by month. Avg = average; ED = emergency department; EMR = electronic medical record; LCL = lower control limit; UCL = upper control limit.
Figure 4
Figure 4. Infusions for status migrainosus by location
Line graph comparing the total number of visits for acute migraine infusions in the infusion center and in the emergency department. ED = emergency department; IC = infusion center.
See this image and copyright information in PMC

Comment in

  • Spotlight on headache.
    Lipton RB. Lipton RB. Neurol Clin Pract. 2019 Jun;9(3):182. doi: 10.1212/CPJ.0000000000000679. Neurol Clin Pract. 2019. PMID: 31342958 Free PMC article. No abstract available.

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