Seizure Type, Frequency, and Time Since Last Seizure Recorded

Measure purpose: Ensure patients or care partners who reported seizure type, seizure frequency for each type of seizure, and date of last seizure for each seizure type at every visit

There are four numerators:

A. Patients or care partners who reported seizure type at every visit.

B. Patients or care partners who reported seizure frequency for each seizure type identified in numerator A at each visit .

C. Patients or care partners who reported time since last seizure for each seizure type identified in numerator A at each visit.

D. Patients or care partners who reported all three measure numerator components A, B, and C at each visit

is divided by

the four denominators (which is the same for A, B, C, D): all visits for patients with primary diagnosis of epilepsy

Allowable exclusions are applicable to all four measures:

Patient declines to provide seizure information on date of encounter.
Patient unable to provide seizure information on date of encounter and no care partner available to provide information or care partner information limited.

Key Phrases

Each measure requires specific key phrases to identify performance.

A. Seizure types are defined as:

Focal Onset – Aware
Focal Onset – Impaired Awareness
Focal Onset – to bilateral tonic-clonic
Generalized Onset – Motor tonic-clonic
Generalized Onset – Other motor
Generalized Onset – Nonmotor (Absence)
Unknown Onset (if focal or generalized) – Motor tonic-clonic
Unknown Onset (if focal or generalized) – Other motor
Unknown Onset (if focal or generalized) – Nonmotor
Unclassified (i.e., unsure if epileptic or not)
Nonepileptic (i.e., psychogenic or physiologic)

B. Seizure frequency is defined as:

Innumerable (i.e., ≥10 per day most days).
Multiple per day (i.e., 4 days per week with ≥ 2 seizures).
Daily (i.e., 4 or more days per week).
Weekly but not daily (i.e., 1–3 per week).
Monthly but not weekly (i.e., 1–3 per month).
At least once per year, but not every month (i.e., 10 or fewer in past 12 months).
Less than once per year.
Frequency not well defined.

Comparative words, such as ‘frequent,’ ‘rare,’ or ‘near daily,’ to describe frequency cannot be used to meet the numerator.

C. Time since last seizure is defined as:

Today
1–6 days ago
1–4 weeks ago
5–12 weeks ago
13–26 weeks ago
6–12 months ago (27–52 weeks ago)
13–24 months ago (53–104 weeks ago)
More than 2 years ago (more than 105 weeks ago)

D. Key phrases are used from above A, B, C components.

Measure Calculation Examples

Dr. Nilsson had 1,000 patient visits between January 1 and December 31 with a diagnosis of epilepsy. This is the denominator for all 4 measures.

During 47 of these visits, patients who were diagnosed with an intellectual disability or were non-communicative lacked a caregiver to provide seizure frequency. These 47 visits are removed from the denominator as they meet exclusions.

Of the remaining 953 visits, Dr. Nilsson documented

patient seizure type in 703 visits. This is the numerator for A.
patient seizure frequency in 384 visits. This is the numerator for B.
Patient time since last seizure for each seizure type at 212 visits. This is the numerator for C.
patient seizure type, seizure frequency, and time since last seizure for each seizure type at 134 visits. This is the numerator for D.

Quality of patient care =

A. 703/(1,000-47). Dr. Nilsson has a score of 73.8% for this measure
B. 384/(1,000-47). Dr. Nilsson has a score of 40.3% for this measure
C. 212/(1,000-47). Dr. Nilsson has a score of 22.2% for this measure
D. 134/(1,000-47). Dr. Nilsson has a score of 14.1% for this measure