AAN Releases Parkinson's Quality Care Measures

December 2010 Monthly Message

- AAN Releases Parkinson's Quality Care Measures
- Policy Year in Review
- PAN/FasterCures Valley of Death paper
- PAN CEO Featured on Comcast Newsmakers
- Support our Advocacy Work
- Parkinson's in the Media

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Will New Parkinson’s Disease Quality Measures Make a Difference in Treatment? 
 
Two weeks ago, the American Association of Neurology (AAN) released a set of 10 quality measures for Parkinson’s disease care.  With this release, the Parkinson’s community has for the first time a set of comprehensive measures that can be used to determine the quality of care.
 
“This is the first set of measures by AAN for Parkinson’s disease, and that certainly gives them weight,” said Eric Cheng, M.D., M.S., the lead researcher of the study.
 
According to a spokesperson for AAN, “We chose Parkinson’s disease as the prototype neurological condition for development of measures.  These measures were developed by an expert panel through literature review of evidence-based and expert recommendations.”
 
Much in the way a proposed government regulation must undergo a public comment period, AAN allowed the public to weigh in regarding the proposed quality-of-care measures.  In fact, according to Dr. Cheng, one of the proposed measures was eliminated, due in large part to the comments received from members of the Parkinson’s community.
 
With the publication of AAN’s measurements (linked here and listed below), physicians can now better determine a patient’s quality of care when:
 
1. Annual Parkinson’s disease diagnosis review:
All patients with a diagnosis of Parkinson’s disease who had their Parkinson’s disease diagnosis reviewed, including a review of current medications and a review for the presence of atypical features (e.g., 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’s disease who were assessed for psychiatric disorders or disturbances (e.g., 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’s 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’s disease (or caregivers, as appropriate) who were queried about symptoms of autonomic dysfunction (e.g., 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’s 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’s disease where patients (or caregivers, as appropriate) were queried about falls.
 
7. Parkinson’s disease rehabilitative therapy options:
All patients with a diagnosis of Parkinson’s disease (or caregivers, as appropriate) who had rehabilitative therapy options (e.g., physical, occupational, or speech therapy) discussed at least annually.
 
8. Parkinson’s disease–related safety issues counseling:
All patients with a diagnosis of Parkinson’s disease (or caregivers, as appropriate) who were counseled about context-specific safety issues appropriate to the patient’s stage of disease (e.g., injury prevention, medication management, or driving) at least annually.
 
9. Querying about Parkinson’s disease medication–related motor complications:
All visits for patients with a diagnosis of Parkinson’s disease where patients (or caregivers, as appropriate) were queried about Parkinson’s disease medication–related motor complications (e.g., wearing off, dyskinesia, or off-time).
 
10. Parkinson’s disease medical and surgical treatment options reviewed:
All patients with a diagnosis of Parkinson’s disease (or caregivers, as appropriate) who had the Parkinson’s disease treatment options (e.g., nonpharmacologic treatment, pharmacologic treatment, or surgical treatment) reviewed at least once annually.
 
These ten measures speak to what researchers see as the best ways to ensure quality care for those living with Parkinson’s disease.
 
But, Parkinson’s Action Network (PAN) Congressional Coordinator Linda Herman is concerned that the measures focus too much on non-motor symptoms.  “The new focus on non-motor symptoms is great news, but it is still important that doctors and the neurological community remain focused on all symptoms of Parkinson’s and the treatment of the whole patient,” she said.
 
Adoption of these measures as a benchmark for quality care is important.  Dr. Cheng said that if Medicare implements the indicators, it’s likely many other private insurance companies would follow suit.
 
Herman is hopeful the measures will lead to an improvement in care, and had one more wish: “It would be useful for people with Parkinson’s to know what their doctors should be checking on at their visits, and initiate discussions on any of these symptoms, if the doctor doesn't do so.”