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Improving Parkinsonís Care with Measures of Quality

The American Academy of Neurology (AAN) has published a new set of guidelines to help doctors assess and improve the quality of care they provide for people with Parkinson’s disease (PD).  These quality measures emphasize nonmotor symptoms that affect quality of life, such as depression and sleep disturbances.  The report appears in the November 30 issue of Neurology.

Measuring the quality of health care is an important step in improving it.  In the past, quality measures have been developed for primary care doctors who treat relatively common conditions like diabetes.  The new report is among the first aimed at specialists who treat a neurological disorder. 

To develop the quality measures, AAN appointed a 28-member panel, which included movement disorder specialists, insurance plan representatives, patient organization representatives (including one from the Parkinson’s Disease Foundation (PDF)), physician coding specialists, and facilitators, as well as AAN staff, a methodologist, a psychiatrist, a neuropsychologist, a psychologist, a family practice physician, and a neurosurgeon.  The panel made recommendations as outlined below:

Results

To provide quality care to people with PD, the report recommends that at least once a year physicians should:

  • Review the PD diagnosis, current medications and any unusual symptoms, including falls at an early stage of PD, poor response to levodopa, motor symptoms equal on both sides of the body at onset, and rapid disease progression.
  • Assess for psychiatric disturbances, including psychosis, depression, anxiety disorder, apathy, or impulse control disorder.
  • Assess for cognitive impairment or dysfunction.
  • Ask people with PD or their care partners about autonomic symptoms such as low blood pressure on standing up, and incontinence.
  • Ask people with PD or their caregivers about sleep disturbances.
  • Discuss physical, occupational and speech therapy as appropriate.
  • Counsel about safety issues related to preventing injuries, managing medication, and driving.
  • Review treatment options, whether medical or surgical.

 

At every visit, physicians caring for people with PD should:

  • Ask about falls.
  • Ask about motor complications of PD medication such as wearing off, dyskinesia or off-time.

What Does it Mean?

The new quality measures reflect the recent recognition among physicians that treating nonmotor symptoms is an important aspect to providing good care to people with PD.  AAN encourages physicians to make use of this report in their practices.  This quality measures recognize that caring for people with PD requires comprehensive evaluation, including assessment of mood, cognition and medications side effects.  However, the guidelines also demonstrate the gaps in evidence with regard to PD treatment.  Studies that assess which of the components of the comprehensive evaluation improve quality of life of people with PD or prolong life are lacking.  Furthermore, the panel did not clarify the tools by which clinicians should evaluate their patients. For example, assessing for cognitive impairment may include simple questions about cognition, or, a full cognitive battery of cognitive testing.  Also needed is an assessment of the time it will take physicians to conduct these comprehensive evaluations.  Physicians’ visits may take longer than previously estimated by Medicare. 

These guidelines may be useful for people living with Parkinson’s in determining whether their own physicians are providing the appropriate assessment of their disease.  Administratively, this tool for assessing quality of care could be used as part of the certification process for clinicians who treat people with PD, or the tools might provide a standard of care necessary for insurance payment.

 

Learn More

What should you keep in mind when visiting your doctor?

Read "You and Your Doctor" from PDF


 

Source Date: Dec 22 2010