The American Academy of Neurology's quality improvement efforts

The American Academy of Neurology (AAN) has a long history of leadership in using principles of evidence-based medicine (EBM) to improve outcomes for our neurologic patients. Starting in 1990, concomitant with the publication of an Institute of Medicine call for development of evidence-based clinical practice guidelines (CPGs),¹ the AAN began developing CPGs. This body of work has resulted in the publication of 90 CPGs. The second stage of evolution in EBM to practice efforts led, beginning in 2010, to the AAN’s development of tools to help us measure processes and outcomes associated with high-quality care: clinical quality measures. Many quality measures are derived from high-quality CPGs. This body of work now encompasses 15 diseases and 139 quality measures.² The third stage of the AAN EBM/quality effort led to the rollout in 2016 of the Axon Registry®,³ a prospective data collection tool that systematically collects and aggregates data for review and analysis. The data, largely reflective of the quality measures, are captured in an automated procedure by the electronic health record (EHR) system of the clinic/institution. The essential function of the reporting function of the registry is “to inform neurologists regarding the quality of their care and provide them with a tool to establish not only performance baselines but progress toward improved quality of care.”³ Patel et al.⁴ recently reported 2 case studies regarding the influence of the Axon Registry on actual practice. These types of studies will be critical in determining the practicalities of this rapidly evolving field for neurologic practices. Additional uses of the Axon Registry will be to contribute to Center for Medicare & Medicaid Services requirements for payment linked to practice improvement and to satisfy Maintenance of Certification requirements by the American Board of Psychiatry and Neurology.