Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2014

Open Access 01-12-2014 | Study protocol

Implementation of the epilepsy center of excellence to improve access to and quality of care – protocol for a mixed methods study

Authors: Mary Jo Pugh, Luci K Leykum, Holly J Lanham, Erin P Finley, Polly H Noël, Katharine K McMillan, Jacqueline A Pugh

Published in: Implementation Science | Issue 1/2014

Login to get access

Abstract

Background

To address the growing problem of epilepsy among aging Veterans and younger Veterans who have experienced a traumatic brain injury (TBI), the Veterans Health Administration (VA) has implemented 16 Epilepsy Centers of Excellence (ECOE) to assure increased access to high quality of care for Veterans with epilepsy. Each ECOE consists of a network of regional hubs to which spoke facilities refer Veterans for subspecialty treatment. The ECOEs are expected to improve access to and quality of epilepsy care through patient care, consultation and education. This study aims to: evaluate the effectiveness of the ECOE structure by describing changes in the quality of and access to care for epilepsy before and after the ECOE initiative using QUality Indicators in Epilepsy Treatment (QUIET Indicators); describe associations between changes in the structure and processes of care and Relational Coordination (RC), a model of task-oriented communication that has been shown to play a role in implementation science; and determine if variations in care are related to levels of RC.

Methods

This four-year comparative case study uses a mixed-methods approach. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data to identify changes in the quality of and access to epilepsy care in the VA between Fiscal Year 2008 and Fiscal Year 2014. Qualitative and survey methods will be used to identify changes in the structure and processes of epilepsy care and RC over the course of the study. We will then link data from the first two objectives to determine the extent to which quality of and access to epilepsy care is associated with RC using multivariable models.

Discussion

This innovative study has the potential to improve understanding of hub-and-spoke model effectiveness, VA epilepsy care, and models of epilepsy specialty care more globally. Moreover, it contributes to implementation science by advancing understanding of the role of RC in the context of a major transformation in the structure of care delivery in a national integrated healthcare system.
Appendix
Available only for authorised users
Literature
1.
Pugh MJ, Cramer J, Knoefel J, Charbonneau A, Mandell A, Kazis L, Berlowitz D: Potentially inappropriate antiepileptic drugs for elderly patients with epilepsy. J Am Geriatr Soc. 2004, 52 (3): 417-422.CrossRefPubMed
2.
Pugh MJ, Van Cott AC, Cramer JA, Knoefel JE, Amuan ME, Tabares J, Ramsay RE, Berlowitz DR: Trends in antiepileptic drug prescribing for older patients with new-onset epilepsy: 2000–2004. Neurology. 2008, 70 (22 Pt 2): 2171-2178.CrossRefPubMed
3.
Pugh MJ, VanCott AC, Steinman MA, Mortensen EM, Amuan ME, Wang CP, Knoefel JE, Berlowitz DR: Choice of antiepileptic drug for older veterans: possible pharmacokinetic drug interactions with existing medications. J Am Geriatr Soc. 2010, 58 (3): 465-471.CrossRefPubMedPubMedCentral
4.
Haneef Z, Stern J, Dewar S, Engel JJ: Referral pattern for epilepsy surgery after evidence-based recommendations: a retrospective study. Neurology. 2010, 75 (8): 699-704. 10.1212/WNL.0b013e3181eee457.CrossRefPubMedPubMedCentral
5.
Labiner DM, Bagic AI, Herman ST, Fountain NB, Walczak TS, Gumnit RJ: Essential services, personnel, and facilities in specialized epilepsy centers-Revised 2010 guidelines. Epilepsia. 2010, 54 (11): 2322-2333.CrossRef
6.
Aldenkamp AP: Cognitive impairment in epilepsy: state of affairs and clinical relevance. Seizure. 2006, 15 (4): 219-220. 10.1016/j.seizure.2006.02.010.CrossRef
7.
Baker GA, Jacoby A, Buck D, Stalgis C, Monnet D: Quality of life of people with epilepsy: a European study. Epilepsia. 1997, 38 (3): 353-362. 10.1111/j.1528-1157.1997.tb01128.x.CrossRefPubMed
8.
Buck D, Baker GA, Jacoby A, Smith DF, Chadwick DW: Patients’ experiences of injury as a result of epilepsy. Epilepsia. 1997, 38 (4): 439-444. 10.1111/j.1528-1157.1997.tb01733.x.CrossRefPubMed
9.
Pugh MJ, Copeland LA, Zeber JE, Cramer JA, Amuan ME, Cavazos JE, Kazis LE: The impact of epilepsy on health status among younger and older adults. Epilepsia. 2005, 46 (11): 1820-1827. 10.1111/j.1528-1167.2005.00291.x.CrossRefPubMed
10.
Sperling MR: The consequences of uncontrolled epilepsy. CNS Spectr. 2004, 9 (2): 98-101.PubMed
11.
Ficker DM: Sudden unexplained death and injury in epilepsy. Epilepsia. 2000, 41 (Supplement 2): S7-S12.CrossRefPubMed
12.
Fisher RS, Vickrey BG, Gibson P, Hermann BP, Penovich P, Scherer A, Walker SM: The impact of epilepsy from the patient’s perspective. I. Descriptions and subjective perceptions. Epilepsy Res. 2000, 41 (1): 39-51. 10.1016/S0920-1211(00)00126-1.CrossRefPubMed
13.
Taylor J, Baker GA: Newly diagnosed epilepsy: cognitive outcome at 5 years. Epilepsy Behav. 2010, 18 (4): 397-403. 10.1016/j.yebeh.2010.05.007.CrossRefPubMed
14.
Jones JE, Hermann BP, Barry JJ, Gilliam FG, Kanner AM, Meador KJ: Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy. Epilepsy Behav. 2003, 4 (Supplement 3): 31-38.CrossRef
15.
Kanner AM: Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment. Biol Psychiatry. 2003, 54 (3): 388-398. 10.1016/S0006-3223(03)00469-4.CrossRefPubMed
16.
Pugh MJ, Zeber JE, Copeland LA, Tabares JV, Cramer JA: Psychiatric disease burden profiles in adults with epilepsy: the association with health services utilization. Psychiatr Serv. 2008, 59 (8): 925-928. 10.1176/appi.ps.59.8.925.CrossRefPubMed
17.
Zeber JE, Copeland LA, Amuan M, Cramer JA, Pugh MJ: The role of comorbid psychiatric conditions in health status in epilepsy. Epilepsy Behav. 2007, 10 (4): 539-546. 10.1016/j.yebeh.2007.02.008.CrossRefPubMed
18.
Begley CE, Famulari M, Annegers JF, Lairson DR, Reynolds TF, Coan S, Dubinsky S, Newmark ME, Leibson C, So EL, Rocca WA: The cost of epilepsy in the United States: an estimate from population-based clinical and survey data. Epilepsia. 2000, 41 (3): 342-352. 10.1111/j.1528-1157.2000.tb00166.x.CrossRefPubMed
19.
Pugh MJ, Berlowitz DR, Rao JK, Shapiro G, Avetisyan R, Hanchate A, Jarrett K, Tabares J, Kazis LE: The quality of care for adults with epilepsy: an initial glimpse using the QUIET measure. BMC Health Serv Res. 2011, 11: 1-10.1186/1472-6963-11-1.CrossRefPubMedPubMedCentral
20.
Fountain N, Van Ness P, Swain-Eng R, Tonn S, Bever C: Quality improvement in neurology: AAN epilepsy quality measures Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Neurology. 2011, 76 (1): 94-99. 10.1212/WNL.0b013e318203e9d1.CrossRefPubMed
21.
McDaniel RRJ, Lanham HJ, Anderson RA: Implications of complex adaptive systems theory for the design of research on health care organizations. Health Care Manage Rev. 2009, 34 (2): 191-199. 10.1097/HMR.0b013e31819c8b38.CrossRefPubMedPubMedCentral
22.
Holland JH: Emergence: From chaos to order. 2000, New York: Oxford University Press
23.
Bar-Yam Y: A mathematical theory of strong emergence using multiscale variety. Complexity. 2004, 9 (6): 15-24. 10.1002/cplx.20029.CrossRef
24.
Jordan ME, Lanham HJ, Crabtree BF, Nutting PA, Miller WL, Stange KC, McDaniel RRJ: The role of conversation in health care interventions: enabling sensemaking and learning. Implement Sci. 2009, 4: 15-10.1186/1748-5908-4-15.CrossRefPubMedPubMedCentral
25.
Lanham HJ, McDaniel RRJ, Crabtree BF, Miller WL, Stange KC, Tallia AF, Nutting P: How improving practice relationships among clinicians and nonclinicians can improve quality in primary care. Jt Comm J Qual Patient Saf. 2009, 35 (9): 457-466.PubMedPubMedCentral
26.
Finley EP, Pugh JA, Lanham HJ, Leykum LK, Cornell J, Veerapaneni P, Parchman ML: Relationship quality and patient-assessed quality of care in VA primary care clinics: development and validation of the work relationships scale. Ann Fam Med. 2013, 11 (6): 543-549. 10.1370/afm.1554.CrossRefPubMedPubMedCentral
27.
Leykum LK, Parchman M, Pugh J, Lawrence V, Noel PH, McDaniel RRJ: The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure. Implement Sci. 2010, 5: 66-10.1186/1748-5908-5-66.CrossRefPubMedPubMedCentral
28.
Leykum LK, Pugh J, Lawrence V, Parchman M, Noel PH, Cornell J, McDaniel RRJ: Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes. Implement Sci. 2007, 2: 28-10.1186/1748-5908-2-28.CrossRefPubMedPubMedCentral
29.
30.
Gittell J, Weiss S: Coordination networks within and across organizations: a multi-level framework. J Manage Stud. 2004, 41 (1): 127-153. 10.1111/j.1467-6486.2004.00424.x.CrossRef
31.
Gittell JH: Coordinating mechanisms in care provider groups: relational coordination as a mediator and input uncertainty as a moderator of performance effects. Manag Sci. 2002, 48 (11): 1408-1426. 10.1287/mnsc.48.11.1408.268.CrossRef
32.
Gittell JH, Fairfield KM, Bierbaum B, Head W, Jackson R, Kelly M, Laskin R, Lipson S, Siliski J, Thornhill T, Zuckerman J: Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients. Med Care. 2000, 38 (8): 807-819. 10.1097/00005650-200008000-00005.CrossRefPubMed
33.
Weinberg DB, Gittell JH, Lusenhop WR, Kautz CM, Wright J: Beyond our walls: impact of patient and provider coordination across the continuum on outcomes for surgical patients. Health Serv Res. 2007, 42 (1p1): 7-24. 10.1111/j.1475-6773.2006.00653.x.CrossRefPubMedPubMedCentral
34.
Vogus TJ, Sutcliffe KM, Weick KE: Doing no harm: enabling, enacting, and elaborating a culture of safety in health care. Acad Manag Perspect. 2010, 24: 60-77.
35.
Leykum LK, Huerta V, Mortensen E: Implementation of a hospitalist-run observation unit and impact on length of stay (LOS): a brief report. J Hosp Med. 2010, 5 (9): E2-5. 10.1002/jhm.642.CrossRefPubMed
36.
Tague NR: Quality Toolbox. 2005, Milwaukee: American Society for Quality: The quality improvement process, 35-51. 2
37.
Farmer T, Robinson K, Elliott SJ, Eyles J: Developing and implementing a triangulation protocol for qualitative health research. Qual Health Res. 2006, 16 (3): 377-394. 10.1177/1049732305285708.CrossRefPubMed
38.
Barbour RS: The case for combining qualitative and quantitative approaches in health services research. J Health Serv Res Policy. 1999, 4 (1): 39-43.PubMed
39.
Institute of Medicine: Epilepsy across the spectrum. 2012, Washington, D.C: The National Academies Press
Metadata
Title
Implementation of the epilepsy center of excellence to improve access to and quality of care – protocol for a mixed methods study
Authors
Mary Jo Pugh
Luci K Leykum
Holly J Lanham
Erin P Finley
Polly H Noël
Katharine K McMillan
Jacqueline A Pugh
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2014
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-9-44

Other articles of this Issue 1/2014

Implementation Science 1/2014 Go to the issue

Methodology

Systematic and transparent inclusion of ethical issues and recommendations in clinical practice guidelines: a six-step approach

Research

Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial: designing the intervention (ClinicalTrials.gov registration NCT01602705)

Study protocol

Designing a strategy to implement optimal conservative treatments in patients with knee or hip osteoarthritis in orthopedic practice: a study protocol of the BART-OP study

Research

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting

Research

Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting

Systematic review

Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review