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Inpatient and Emergency Neurology Quality Measurement Set

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Inpatient and Emergency Neurology Quality Measurement Set Inpatient and Emergency Neurology Quality Measurement Set ©2016. American Academy of Neurology. All Rights Reserved. 1 CPT Copyright 2004-2016 American Medical Association. Disclaimer Performance Measures (Measures) and related data specifications developed by the American Academy of Neurology (AAN) are intended to facilitate quality improvement activities by providers. AAN Measures: 1) are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications; 2) are not continually updated and may not reflect the most recent information; and 3) are subject to review and may be revised or rescinded at any time by the AAN. The measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by health care providers in connection with their practices); they must not be altered without prior written approval from the AAN. Commercial use is defined as the sale, license, or distribution of the measures for commercial gain, or incorporation of the measures into a product or service that is sold, licensed, or distributed for commercial gain. Commercial uses of the measures require a license agreement between the user and the AAN. Neither the AAN nor its members are responsible for any use of the measures. AAN Measures and related data specifications do not mandate any particular course of medical care and are not intended to substitute for the independent professional judgment of the treating provider, as the information does not account for individual variation among patients. In all cases, the selected course of action should be considered by the treating provider in the context of treating the individual patient. Use of the information is voluntary. AAN provides this information on an “as is” basis, and makes no warranty, expressed or implied, regarding the information. AAN specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. AAN assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. ©2016 American Academy of Neurology. All rights reserved. Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary coding sets should obtain all necessary licenses from the owners of these code sets. The AAN and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications. ICD-10 copyright 2012 International Health Terminology Standards Development Organization CPT ® is a registered trademark of the American Medical Association and is copyright 2016. CPT® codes contained in the Measure specifications are copyright 2004-2016 American Medical Association. ©2016. American Academy of Neurology. All Rights Reserved. 2 CPT Copyright 2004-2016 American Medical Association. Table of Contents Work Group Participants ..............................................................................................................4 Invited Organizations ....................................................................................................................... 4 Improving Outcomes for Patients in Inpatient or Emergency Care .............................................5 Topic Importance ............................................................................................................................. 5 Clinical Evidence Base .................................................................................................................... 6 Work Group Recommendations ...................................................................................................... 7 Definitions and Abbreviations ......................................................................................................... 7 Desired Outcomes ............................................................................................................................ 8 Intended Care Audience, Settings, and Patient Populations .......................................................... 10 Other Potential Measures ............................................................................................................... 10 Measure Harmonization ................................................................................................................. 11 Technical Specifications Overview ............................................................................................... 11 Measure Exceptions ....................................................................................................................... 11 Testing and Implementation of the Measurement Set ................................................................... 11 Inpatient and Emergency Measures ................................................................................................... 12 Documentation of Brain Death ...................................................................................................... 12 Reduction of Urinary Catheters for Patients with Neurological Conditions .................................. 15 Delirium Risk Factor Screening and Preventative Protocol .......................................................... 19 Non-pharmacological Treatment of Delirium ................................................................................ 24 Immunosuppressive Treatment for GBS ....................................................................................... 29 Immunosuppressive Therapy for Myasthenic Crisis ..................................................................... 32 Status Epilepticus Identification and Seizure Cessation ................................................................ 35 Status Epilepticus Treatment with Antiepileptic ........................................................................... 40 EEG for Status Epilepticus and Coma ........................................................................................... 43 Discussion and Documentation of Advanced Directives ............................................................... 46 Discussion and Documentation of Goals of Care .......................................................................... 50 Treatment of Bacterial Meningitis ................................................................................................. 53 Contact Information ................................................................................................................................ 56 References ............................................................................................................................................... 56 ©2016. American Academy of Neurology. All Rights Reserved. 3 CPT Copyright 2004-2016 American Medical Association. Work Group Participants Chairs John Ferro, MD, MS, FAAN (American Academy of Neurology) S. Andrew Josephson, MD, FAAN (Neurohospitalist Society) Paul Vespa, MD, FAAN (Neurocritical Care Society) Work Group Members American Academy of Neurology Child Neurology Society Rohit Das, MD, MPH Charlotte Jones, MD, PhD, MSPH David Gloss, MD David Jones, MD Neurocritical Care Society Kevin Sheth, MD, FAAN, FNCS, FAHA, American Association of Neurological FCCM Surgeons/Congress of Neurological Navaz Karanjia, MD Surgeons Salvador Cruz-Flores, MD, MPH, FAAN William Mack, MD, MS, FAANS, FAHA Corey Fehnel, MD, MPH American Association of Neuroscience Neurohospitalist Society Nurses John Probasco, MD Virginia Prendergast, PhD, NP-C Mark Rubin, MD Jennifer Simpson, MD American College of Radiology/American Jana Wold, MD Society of Neuroradiology Chip Truwit, MD Facilitators Adam Webb, MD (American Academy of American Epilepsy Society Neurology) Paul Van Ness, MD Adam Cohen, MD (American Academy of Neurology) American Geriatrics Society Michael Perskin, MD Staff Erin Lee Amy Bennett, JD American Psychiatric Association Gina Gjorvad Sanjeev Sockalingam, MD, FRCPC Becky Schierman, MPH Invited Organizations The following organizations were invited to participate, but declined: American Neurological Association, American College of Emergency Physicians ©2016. American Academy of Neurology. All Rights Reserved. 4 CPT Copyright 2004-2016 American Medical Association. Improving Outcomes for Patients Purpose of Measures In 2015, the American Academy of Neurology (AAN), Neurocritical Care Society (NCS), and Neurohospitalist Society (NHS) formed an Inpatient and Emergency Neurology Work Group (Work Group) to review existing guidelines, current evidence, and gaps in care in order to develop a measurement set for inpatient and emergency neurology that promotes quality improvement and drives better outcomes for neurologically-ill patients for inpatient and emergency settings. The AAN, NCS, and NHS are developing quality measures based on the belief that specialists should play a major role in selecting and creating measures that will drive performance improvement and possibly be used in accountability programs in the future. The AAN, NCS, and NHS formed the Work Group with representatives from professional associations and patient advocacy organizations to ensure any measures developed included input from all members of the healthcare team. All members of the Work Group were required to disclose relationships with industry and other entities to avoid actual, potential, or perceived conflicts of interest. No one measurement
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