Open Access Open Badges Research article

The quality of care for adults with epilepsy: an initial glimpse using the QUIET measure

Mary Jo Pugh12*, Dan R Berlowitz34, Jaya K Rao5, Gabriel Shapiro46, Ruzan Avetisyan4, Amresh Hanchate7, Kelli Jarrett4, Jeffrey Tabares1 and Lewis E Kazis38

Author Affiliations

1 South Texas Veterans Health Care System, VERDICT REAP, (7400 Merton Minter), San Antonio, TX, (78229), USA

2 University of Texas Health Science Center at San Antonio, Department of Epidemiology and Biostatistics, (7703 Floyd Curl Drive), San Antonio, TX, (78229) USA

3 Center for Health Quality, Outcomes and Economic Research (CHQOER), Veterans Administration Medical Center, (200 Springs Road), Bedford, MA, (01730), USA

4 Boston University School of Public Health, Health Policy and Management, (715 Albany St, Talbot Building), Boston, MA, (02118), USA

5 University of North Carolina, Eshelman School of Pharmacy, (Kerr Hall, Room 2202) Chapel Hill, NC, (27599), USA

6 Hôpital Sainte-Justine, Université de Montréal, (3175, Chemin de la Côte-Sainte-Catherine), Montreal, Quebec, (H3T 1C5), Canada

7 Boston Veterans Administration Medical Center, Center for Organization, Leadership, and Management Research, (150 South Huntington Ave.), Jamaica Plain, MA, (02130), USA

8 Center for the Assessment of Pharmaceutical Practices (CAPP) and Pharmaceutical Assessment Management and Policy (PAMP), Department of Health Policy and Management, Boston University School of Public Health, (715 Albany St, Talbot Building), Boston, MA, (02118), USA

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BMC Health Services Research 2011, 11:1  doi:10.1186/1472-6963-11-1

Published: 3 January 2011



We examined the quality of adult epilepsy care using the Quality Indicators in Epilepsy Treatment (QUIET) measure, and variations in quality based on the source of epilepsy care.


We identified 311 individuals with epilepsy diagnosis between 2004 and 2007 in a tertiary medical center in New England. We abstracted medical charts to identify the extent to which participants received quality indicator (QI) concordant care for individual QI's and the proportion of recommended care processes completed for different aspects of epilepsy care over a two year period. Finally, we compared the proportion of recommended care processes completed for those receiving care only in primary care, neurology clinics, or care shared between primary care and neurology providers.


The mean proportion of concordant care by indicator was 55.6 (standard deviation = 31.5). Of the 1985 possible care processes, 877 (44.2%) were performed; care specific to women had the lowest concordance (37% vs. 42% [first seizure evaluation], 44% [initial epilepsy treatment], 45% [chronic care]). Individuals receiving shared care had more aspects of QI concordant care performed than did those receiving neurology care for initial treatment (53% vs. 43%; X2 = 9.0; p = 0.01) and chronic epilepsy care (55% vs. 42%; X2 = 30.2; p < 0.001).


Similar to most other chronic diseases, less than half of recommended care processes were performed. Further investigation is needed to understand whether a shared-care model enhances quality of care, and if so, how it leads to improvements in quality.