Objective: To investigate whether adherence to PD QIMs affect patient outcomes.

Background: The development of QIMs is linked to the belief that physician reimbursement should be more standardized and objective, and the effort to promote more comprehensive and standardized care of patients. The American Academy of Neurology was quick to adopt quality measures and apply them to chronic conditions like PD. Medicare and private health insurance are increasingly adopting QIMs as the basis for “pay for performance" models. This study investigates if the 10 AAN PD QIMs affect patient outcomes.

Methods: We conducted a retrospective chart review of PD patients seen at our institution to assess compliance of movement disorders specialists with documentation for each of the 10 PD QIMs over a year. Outcomes data was collected based on review of medical records and prospective data collected from our longitudinal database. For each PD patient, we used a visit date range in 2013 as the index date. We then analyzed correlations between the number of QIMs documented during the year before the index date, with the outcomes observed over the following year. Outcomes (PD severity, disability, quality of life, hospital/outpatient visits, rehab referrals, nursing home placements) were examined over one year since all PD QIMs require documentation a minimum of once per year.

Results: 52 patients were reviewed for all PD visits over one year. Only one outcome showed a correlation with documentation, a direct correlation (r=0.44) between QIM adherence and the number of referrals to rehab in the year prior to the index visit (p=0.02) and there was an indirect correlation (r= 0.48,p=0.02) for adherence over the following year. This indicates that greater QIM documentation, was associated with more referrals that year, and less referrals were made in the subsequent year. No other outcome showed a correlation with QIM documentation.

Conclusions: This study shows that documentation supporting QIMs in PD was not associated with a range of outcomes. The only outcome associated with documentation was the frequency of referrals for rehabilitation therapy. To our knowledge, this is the first study of the association of medical documentation and QIMs in PD. These results illustrate the need for more research into the value of QIMs since adherence to QIMs should result in improved outcomes.

AAN 2016 Annual Meeting.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-pd-quality-improvement-measures-qim-and-outcomes-study/