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Improving the quality of care for patients with neurotology conditions

Posted by Cynthia Ryan

Five new neurotology quality measures created through a multi-disciplinary collaboration.

By Habib Rizk, MD and Anant Shenoy, MD

The American Academy of Neurology (AAN) and American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS), in concert with patient representatives from VeDA, have created five new quality measures for patients with neurotology conditions. Quality measures are indicators of adequate health care services given to a patient in line with current medical knowledge. They also directly measure patient health outcomes. These measures are intended to help doctors, patients, and treatment teams. The five new measures cover the topics listed below.

AAN & AAO-HNS Neurotology Quality Measurement Set

  1. Quality of life for patients with neurotology disorders

  2. Vestibular rehabilitation for unilateral or bilateral vestibular hypofunction

  3. Dix-Hallpike maneuver performed with patients with benign paroxysmal positional vertigo (BBPV)

  4. Canalith Repositioning Procedure (CRP) performed for patients with posterior canal BPPV

  5. Standard BPPV management

Doctors do not need to integrate all of these measures in their practice at one time. It is recommended that they pick one or two that would be the most meaningful to the patients they see and use this information to drive improvement of the care they provide over time. The measures are intended for any doctor, advance practice providers, audiologists, physical therapist, or occupational therapist involved in the care of vestibular patients.

An example of how quality measures are used is helpful. Dr. Igbe sees patients diagnosed with benign paroxysmal positional vertigo (BPPV) and vestibular migraine and is interested in knowing how her treatment follows the quality measures. Dr. Igbe looks over the list of measures and decides that monitoring her patients’ quality of life is the measure she wants to focus on first. In 2017, Dr. Igbe saw 50 patients diagnosed with BPPV and vestibular migraine and asked them to complete a quality of life screening form.  Four patients declined to fill out the form. When she saw the 46 patients again later in the year they completed the screening form again.  34 patients had scores that were the same or better than the first visit. We can calculate that this measure was met for 75% of her patients this year.

34/(50-4)=75%

Based on this information and her goal of improving her patients’ quality of life, she and her treatment team can work to keep improving this rate in future years. In the example above, Dr. Igbe could improve her quality in several ways. She may begin by asking patients about topics that can impact their quality of life like lifestyle changes, medication side effects, or mood or anxiety concerns.  Her practice may decide to have nurses or medical assistants ask patients to complete these screening forms while they wait for the visit or send them via a patient portal in advance of the visit. That way Dr. Igbe can spend time reviewing the answers a patient provided in the visit rather than asking the questions. She may also create a standardized list of resources for patients explaining what resources are available in the nearby area and on the internet to meet common concerns raised by her patients, such as for example helping them identify appropriate physical therapists that can handle their episodic BPPV.

If your treatment team is asking you to complete these surveys, please do so and answer truthfully all the questions asked. If you don’t understand a question, ask for help.

These measures are a start, and they will be updated over time to reflect advances in evidence. The AAN & AAO-HNS have additional resources to help patients understand medical evidence such as guideline statements.

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