Development of evidence-based quality indicators for deep brain stimulation in patients with Parkinson's disease and first year experience of implementation of a nation-wide registry

Kirsten Haas; Stephanie Stangl; Frank Steigerwald; Cordula Matthies; Doreen Gruber; Andrea A Kühn; Joachim K Krauss; Friederike Sixel-Döring; Kajetan von Eckardstein; Günther Deuschl; Joseph Classen; Dirk Winkler; Jürgen Voges; Imke Galazky; Wolfgang Oertel; Andres O Ceballos-Baumann; Max Lange; Alireza Gharabaghi; Daniel T Weiss; Jens Volkmann; Peter U Heuschmann

doi:10.1016/j.parkreldis.2019.01.016

Development of evidence-based quality indicators for deep brain stimulation in patients with Parkinson's disease and first year experience of implementation of a nation-wide registry

Parkinsonism Relat Disord. 2019 Mar:60:3-9. doi: 10.1016/j.parkreldis.2019.01.016. Epub 2019 Feb 5.

Authors

Kirsten Haas¹, Stephanie Stangl¹, Frank Steigerwald², Cordula Matthies³, Doreen Gruber⁴, Andrea A Kühn⁵, Joachim K Krauss⁶, Friederike Sixel-Döring⁷, Kajetan von Eckardstein⁸, Günther Deuschl⁹, Joseph Classen¹⁰, Dirk Winkler¹¹, Jürgen Voges¹², Imke Galazky¹³, Wolfgang Oertel¹⁴, Andres O Ceballos-Baumann¹⁵, Max Lange¹⁶, Alireza Gharabaghi¹⁷, Daniel T Weiss¹⁸, Jens Volkmann¹⁹, Peter U Heuschmann²⁰

Affiliations

¹ Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
² Department of Neurology, University of Würzburg, Würzburg, Germany.
³ Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany.
⁴ Kliniken Beelitz, Movement Disorder Clinic, Beelitz-Heilstätten, Germany.
⁵ Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - University Medicine (CCM), Berlin, Germany.
⁶ Department of Neurosurgery, Medical School Hannover, Hannover, Germany.
⁷ Paracelsus-Elena Hospital, Kassel, Germany; Department of Neurology, Philipps-University Marburg, Germany.
⁸ Department of Neurosurgery, University Medicine Göttingen, Georg-August University, Göttingen, Germany.
⁹ Department of Neurology, Christian-Albrecht-University, Kiel, Germany.
¹⁰ Department of Neurology, University of Leipzig, Leipzig, Germany.
¹¹ Faculty of Medicine, Department of Neurosurgery, University Clinic of Leipzig, Leipzig, Germany.
¹² Leibniz Institute for Neurobiology, Magdeburg, Germany; Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
¹³ Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.
¹⁴ Department of Neurology, Philipps-University Marburg, Germany.
¹⁵ Schön Klinik München Schwabing, Department of Neurology, Technische Universität München, München, Germany.
¹⁶ Department of Neurosurgery, University of Regensburg, Medical Center, Regensburg, Germany.
¹⁷ Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, University of Tuebingen, Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany.
¹⁸ Centre of Neurology, Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Germany.
¹⁹ Department of Neurology, University of Würzburg, Würzburg, Germany. Electronic address: Volkmann_J@ukw.de.
²⁰ Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University Würzburg, Clincial Trial Center Würzburg, University Hospital Würzburg, Germany.

PMID: 30772278
DOI: 10.1016/j.parkreldis.2019.01.016

Abstract

Introduction: Deep Brain Stimulation (DBS) is a complex, invasive and cost-intensive therapy that requires a high level of expertise. To date, data on quality of DBS in clinical routine in the German health care system are lacking.

Methods: The development of evidence-based QIs for DBS in PD patients was performed following a standardized process by a multidisciplinary board between 2014 and 2016. The process was initiated by the German Parkinson Society and followed international recommendations for developing QIs including: a systematic literature search; an appraisal of the published evidence; a consensus-based selection of the QI set; and a pilot study to assess the feasibility in implementing the QIs in clinical routine.

Results: A set of 28 QIs for determining the quality of DBS in PD was established by the board covering different dimensions of health care quality (structure, process, and outcome) in different treatment phases of DBS care (pre-operative, peri-operative, and post-operative). Implementation in clinical practice was tested in a pilot study comprising three hospitals delivering DBS care. The feasibility of the QI set was evaluated positively by the participating physicians and hospitals. Mean time to document one patient was 25 min. The German-wide implementation of the defined indicator set within a dedicated quality registry (QualiPa) started in June 2016.

Conclusion: QIs are a necessary requirement to monitor hospital performance in DBS care. The evidence-based approach to develop the proposed indicator set is expected to assure transparency, acceptance and long-term applicability of the QI set in Germany.

Keywords: Deep brain stimulation; Morbus Parkinson; Parkinson's disease; Performance measure; Quality indicator.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Deep Brain Stimulation / standards*
Evidence-Based Medicine / standards*
Germany
Humans
Parkinson Disease / therapy*
Quality Indicators, Health Care / standards*
Registries / standards*