The impact of updates in headache quality measures on adherence to best practices in a neurology resident clinic: A quality improvement study

• Published in: Headache 2024-11, Vol.64 (10), p.1329-1335
• Main Authors: Cascella, Robert H., Anderson, Christopher C., Perez, Enmanuel J.
• Format: Article
• Language: English
• Subjects: Adult; Best practice; Clusters; education; Electronic health records; Electronic medical records; Female; Guideline Adherence - standards; Guideline Adherence - statistics & numerical data; Headache; Headache - drug therapy; Headache - therapy; headache quality measures; Headaches; Humans; Internship and Residency - standards; Intervention; Male; Management; Medical personnel; Migraine; Migraine Disorders - drug therapy; Migraine Disorders - therapy; Neurology; Neurology - standards; Patients; Practice Guidelines as Topic - standards; Quality control; Quality improvement; Quality Improvement - standards; Retrospective Studies; Statistical analysis; survey; Surveys; trainee‐led study
• ISSN: 0017-8748; 1526-4610; 1526-4610
• DOI: 10.1111/head.14754

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