The Joint Commission (TJC)/Disease-Specific Care (DSC) Certification Programs for Parkinson's Disease (PD)/Multiple Sclerosis (MS)/Amyotrophic Lateral Sclerosis (ALS) - A Structured Mechanism Developed for Guideline-Directed Performance Measure Implementation, Audit and Compliance Assessment Allowing Evolution from Process-Based to Patient-Outcome-Based Improvement in Patient Care at Carolinas Medical Center (P04.189)

OBJECTIVE: Measure and document compliance with core performance measures of the PD/MS/ALS DSC profiles, demonstrate patient-specific outcome measure compliance and demonstrate ability to transition to further performance measures at a large academic medical center over 24 months. BACKGROUND: TJC/DSC Certification is a clinic-based process that assesses implementation of performance measures based on known guidelines (www.jointcommission.org/certification/diseasespecific_care.aspx). The reiterative process was introduced to improve the quality of patient care by reducing variation in clinical processes reducing the risk of error, develop a framework for program structure and management using effective data-driven performance improvement, provide an objective assessment of clinical excellence, and potentially meet necessary regulatory requirements. The process is amenable to existing guidelines and performance measures recently developed by the American Academy of Neurology(AAN). DESIGN/METHODS: Standardized performance measures defined by AAN/National Patient Safety goals:(1) Cognitive [Mini-Mental Status Examination[MMSE](PD/ALS), Digit-Span(MS)], (2) Depression[Patient Health Questionnaire[PHQ-2/PHQ-9](ALS), Geriatric Depression Scale(PD), Beck Depression Scale(MS)], (3)Falls Assessment (PD), (4)25-Foot-Walk(MS), (5)Communication with primary care physician(PCP) (PD/MS/ALS), (6)Respiratory Management Assessment(RMA) (ALS) were monitored at Carolinas Medical Center with monthly/quarterly audits of performance ascertained in 538 PD, 1574 MS and 311 ALS patients across 1754±332(SD)PD, 3627±592 MS, 1406±384 ALS annual encounters over two years. RESULTS: Monthly audits indicated high protocol compliance in (1)cognitive-screening[98.9±11.7%], (2)depression-screening[98.4±17.4%], (3)falls assessment [96.2±19.2%], (4)25-Foot-Walk[98.8±5.7%], (5)communications with PCP[85.5±16.8%]assessments across the disease programs according to practice standards. (6)RMA identified functional vital capacity(FVC) measurement as universal(100.0±0.0%)and the measure was adjusted to assess the proportion of patients with FVC CONCLUSIONS: TJC/DSC certification is a clinic-based process for implementing performance measures to improve PD/MS/ALS clinic performance at Carolinas Medical Center. Deployment of performance measures was accomplished with compliance achieving benchmark targets providing an improved culture of guideline-based patient care with mechanisms in place to audit and continually verify adherence. The TJC/DSC certification process allows regular addition of new performance measures to achieve these ends. Supported by: Carolinas Healthcare Foundation. Disclosure: Dr. Conway has received personal compensation for activities with Bayer, Biogen Idec, Teva Neuroscience, EMD Serono, and Pfizer Inc. Dr Conway has received research support from Eli Lilly & Company, the National Institutes of Health, Novartis, EMD Serono, Biogen Idec, Duke Murdock Study, AB Science, Avanir Pharmaceuticals, Roche/PPDi, Genentech, Inc., Opexa, and National Multiple Sclerosis Society. Dr. Englert has received personal compensation for activities with Medtronic, Inc., Teva Neuroscience, and UCB Pharma. Dr. Englert has received research support from Schering-Plough, Schwarz Bioscience, and Teva Neuroscience. Dr. Bravver has received research support from Biogen-Idec Pharmaceuticals, Avanir Pharmaceuticals, Cytokinetics Pharmaceuticals, Neuraltus Pharmaceuticals, Glaxo-Smith Kline Pharmaceuticals, NINDS Clinical Research Consortium. Dr. Craig has nothing to disclose. Dr. Williams has nothing to disclose. Dr. Cashdollar has nothing to disclose. Dr. Price has nothing to disclose. Dr. Fortier has nothing to disclose. Dr. Kaufman has received personal compensation for actiities with Acorda, BiogenIdec, Genzyme, Novartis and Teva Neuroscience. Dr. Brooks has received personal compensation for activities with Biogen Idec, Avanir Pharmaceuticals, Acorda Therapeutics, Cytokinetics, Synapse, and the National Institute of Neurological Disorders and Stroke. Dr. Brooks has received research support from Biogen Idec, Avanir Pharmaceuticals, Cytokinetics, Neuraltus, GlaxoSmithKline, Inc., and the National Institute of Neurological Disorders and Stroke. Dr. Iyer has received research support from Schering-Plough, Schwarz Biosciences, and Teva Neuroscience.