Abstract：
OBJECTIVE: To apply the 2019 joint American Academy of Neurology (AAN) and American Headache Society (AHS) quality measures for headache management to a cohort of neurology resident physicians and then assess outcomes related to guideline adherence.
BACKGROUND: The optimization of headache management is essential to reduce both the individual and systemic impact of these disorders. In 2014, the AAN developed 10 quality measures for evidence-based management of patients with headache. A workgroup updated and condensed its headache quality measures in 2019, narrowing the set to six measurements, four of which would primarily focus on the management of migraine and two of which would address the management of cluster headache.
METHODS: This quality improvement study was conducted using a pretest-posttest study design. A pre-intervention survey based on retrospective analysis of five clinic notes for adherence to the measures was designed and distributed to all neurology residents (n = 32) at a large, academic tertiary referral center. The intervention included the creation of an electronic medical record template to aid residents in following the measures during clinical encounters, as well as the provision of direct feedback based on pre-intervention results. Finally, a post-intervention survey was distributed for completion based on notes written during the intervention period. Analysis was limited to migraine, given the low percentage of cluster headache seen in clinic.
RESULTS: An increase in adherence was seen in three of the four migraine-related quality measures, with the Use of Abortive Medications for Migraine and Documentation of Counseling on Modifiable Lifestyle and Chronification Factors demonstrating statistically significant improvements (75.8% to 88.0% [p = 0.013] and 83.9% to 94.0% [p = 0.029] adherence, respectively). For secondary outcomes, the increase in the utilization of appropriate diagnostic criteria (82.6% to 93.2%, p = 0.018) was significant, and the self-assessed confidence rating for adherence to guidelines was significant (p < 0.001).
CONCLUSIONS: This study provides evidence that the quality improvement intervention led to increased adherence to the AAN and AHS migraine-related measures. It is anticipated that increased adherence may lead to improved patient outcomes.
BACKGROUND: The optimization of headache management is essential to reduce both the individual and systemic impact of these disorders. In 2014, the AAN developed 10 quality measures for evidence-based management of patients with headache. A workgroup updated and condensed its headache quality measures in 2019, narrowing the set to six measurements, four of which would primarily focus on the management of migraine and two of which would address the management of cluster headache.
METHODS: This quality improvement study was conducted using a pretest-posttest study design. A pre-intervention survey based on retrospective analysis of five clinic notes for adherence to the measures was designed and distributed to all neurology residents (n = 32) at a large, academic tertiary referral center. The intervention included the creation of an electronic medical record template to aid residents in following the measures during clinical encounters, as well as the provision of direct feedback based on pre-intervention results. Finally, a post-intervention survey was distributed for completion based on notes written during the intervention period. Analysis was limited to migraine, given the low percentage of cluster headache seen in clinic.
RESULTS: An increase in adherence was seen in three of the four migraine-related quality measures, with the Use of Abortive Medications for Migraine and Documentation of Counseling on Modifiable Lifestyle and Chronification Factors demonstrating statistically significant improvements (75.8% to 88.0% [p = 0.013] and 83.9% to 94.0% [p = 0.029] adherence, respectively). For secondary outcomes, the increase in the utilization of appropriate diagnostic criteria (82.6% to 93.2%, p = 0.018) was significant, and the self-assessed confidence rating for adherence to guidelines was significant (p < 0.001).
CONCLUSIONS: This study provides evidence that the quality improvement intervention led to increased adherence to the AAN and AHS migraine-related measures. It is anticipated that increased adherence may lead to improved patient outcomes.
摘要：
目标：将2019年美国神经病学会（AAN）和美国头痛学会（AHS）联合的头痛管理质量措施应用于神经内科住院医师队列，然后评估与指南依从性相关的结果。
背景：优化头痛管理对于减少这些疾病的个体和全身影响至关重要。2014年，AAN制定了10项质量措施，用于头痛患者的循证管理。一个工作组在2019年更新并浓缩了其令人头疼的质量衡量标准，将范围缩小到六个衡量标准，其中四项将主要侧重于偏头痛的管理，两项将解决丛集性头痛的管理。
方法：本质量改进研究采用前测-后测研究设计进行。基于对遵守这些措施的五个临床记录的回顾性分析，设计了一项干预前调查，并分发给所有神经科居民（n=32），学术三级转诊中心。干预措施包括创建电子病历模板，以帮助居民在临床遇到时遵循这些措施，以及根据干预前结果提供直接反馈。最后,我们根据干预期间撰写的笔记分发了干预后调查以完成.分析仅限于偏头痛,考虑到临床上出现的丛集性头痛的比例较低。
结果：在四个偏头痛相关质量指标中的三个中，依从性增加，使用堕胎药物治疗偏头痛，并记录可改变的生活方式和时间因素的咨询，证明有统计学意义的改善（75.8％至88.0％[p=0.013]和83.9％至94.0％[p=0.029]，分别)。对于次要结果，适当诊断标准利用率的提高(82.6%至93.2%，p=0.018)是显著的，对遵循指南的自我评估信心评分显著(p<0.001).
结论：这项研究提供了证据，证明质量改进干预导致对AAN和AHS偏头痛相关措施的依从性增加。预期增加的依从性可导致改善的患者结果。
背景：优化头痛管理对于减少这些疾病的个体和全身影响至关重要。2014年，AAN制定了10项质量措施，用于头痛患者的循证管理。一个工作组在2019年更新并浓缩了其令人头疼的质量衡量标准，将范围缩小到六个衡量标准，其中四项将主要侧重于偏头痛的管理，两项将解决丛集性头痛的管理。
方法：本质量改进研究采用前测-后测研究设计进行。基于对遵守这些措施的五个临床记录的回顾性分析，设计了一项干预前调查，并分发给所有神经科居民（n=32），学术三级转诊中心。干预措施包括创建电子病历模板，以帮助居民在临床遇到时遵循这些措施，以及根据干预前结果提供直接反馈。最后,我们根据干预期间撰写的笔记分发了干预后调查以完成.分析仅限于偏头痛,考虑到临床上出现的丛集性头痛的比例较低。
结果：在四个偏头痛相关质量指标中的三个中，依从性增加，使用堕胎药物治疗偏头痛，并记录可改变的生活方式和时间因素的咨询，证明有统计学意义的改善（75.8％至88.0％[p=0.013]和83.9％至94.0％[p=0.029]，分别)。对于次要结果，适当诊断标准利用率的提高(82.6%至93.2%，p=0.018)是显著的，对遵循指南的自我评估信心评分显著(p<0.001).
结论：这项研究提供了证据，证明质量改进干预导致对AAN和AHS偏头痛相关措施的依从性增加。预期增加的依从性可导致改善的患者结果。
