Initial report from Axon care registry identifies opportunities for improvement

The baseline assessment of the quality of neurologic care reported in the Axon Registry demonstrated modest performance scores and variability across measures and providers, according to study results published in Neurology.

“This initial description of ambulatory quality of neurologic care from the Axon Registry demonstrates variability in quality measure performance and opportunities for improvement in measure performance and measure design,” Andrew M. Wilson, MD, MS, MBA, of the department of neurology at the University of California Los Angeles (ULCA) and the Greater Los Angeles Healthcare System, and colleagues wrote. “While insufficient documentation and limitations in data abstraction can affect measure performance, the utility of indicators lies in demonstrating that they have the capacity to identify opportunities for improving care. We believe that through thoughtful measure development, precise mapping of [electronic health record (EHR)] data, and proper clinical documentation the Axon Registry will continue to be an invaluable tool to improve and report clinical neurology quality measures.”

The American Academy of Neurology launched the Axon Registry in 2015 to give members a platform for measurement, improvement and reporting of clinical neurology quality measures. Following data validation and internal process improvement, it “has been used as a practice-level quality improvement tool,” the researchers wrote.

Wilson and colleagues described characteristics of registry participants and performance of neurology providers on 20 of the 2019 Axon Registry quality measures. The study included 948 neurology providers who contributed 6,480 provider-metric observations. They calculated the median performance for each quality measure using the distribution of providers’ scores on a quality measure.

“Of the 1,023 total providers in 2019, 948 (93%) providers had actively implemented a

quality measure, and thus were included in the 2019 performance measure analysis,” Wilson and colleagues wrote. “Of included providers, 184 (19%) practice in the Northeast, 326 (34%) in the South, 297 (31%) in the Midwest, and 141 (15%) in the West. About 29% of providers work in a practice size with less than 10 providers, 18% work in a practice size of 10-30 providers, and 53% work in a practice size greater than 30 providers.”

Investigators determined correlations between quality measure performance, provider characteristics and intrinsic measure parameters.

The researchers found that the average quality measure performance score at provider level overall was 66. The average quality measure performance score was 53 at the measure level (n = 20), with a range of 2-100.

“Measures with a lower complexity category (eg, discrete orders, singular concepts) or developed through the specialty’s qualified clinical data registry (QCDR) pathway had higher performance distributions,” Wilson and colleagues wrote. “There was no difference in performance between Merit-based Incentive Payment System (MIPS) and non-MIPS providers.”

They noted no correlation between quality measure performance and practice size, measure clinical topic/neurological condition, or measure year of entry.

“These findings serve as a baseline assessment of quality of ambulatory neurologic care in the U.S. and provide insights into future measure design,” the researchers wrote.

In a related editorial, Koryu Sato, MPH, of the department of social epidemiology in the Graduate School of Medicine and School of Public Health at Kyoto University in Japan, and Yusuke Tsugawa, MD, PhD, of the division of general internal medicine and health services research at UCLA’s David Geffen School of Medicine and the department of health policy and management at UCLA’s Fielding School of Public Health, wrote that the Axon Registry demonstrated “the need for valid and reliable measurements” and acknowledged there is room for improvements in the quality of neurologic care in the United States.

Sato and Tsugawa noted that Wilson and colleagues observed many invalid records in the registry, which they acknowledged in the study results.

“The U.S. health system continues to face many challenges to measure and improve the

quality of health care, using complex metrics and incentive structures,” Koryu and Tsugawa said. “Nonetheless, we cannot improve things we do not measure, and thus, accurate measurements of the quality of care are a critical initial step toward improving care quality. Increased availability of rich data from claims, electronic health records, and other data sources may enable us to measure the quality of care more accurately and in a more timely way, and a better understanding of physicians’ decision-making process may enable us to design interventions that are more effective in improving physician behaviors.”