Dr. Justin Martello leads groundbreaking effort to improve neurology care

For a national quality initiative to improve patient care, the American Academy of Neurology tapped Christiana Care neurologist Justin P. Martello, M.D., to lead a work group, which published its findings and recommendations in the the journal Neurology.

Dr. Martello, lead author on the article “Quality Improvement in Neurology: Universal Neurology Quality Measurement Set,” is part of groundbreaking work dedicated to improving neurologic patient care by evaluating universal quality measures for all neurologists.

Existing general quality measurements, such as questions regarding smoking or immunization, were not neurology-specific.

However, quality measurements for each subspecialty — such as epilepsy or Parkinson’s disease — were too narrow.

“The general neurologist sees a variety of patients,” wrote Dr. Martello. “We need quality measures that are easy to adhere to and to report.”

In the work group’s initiative, one quality measure group focused on the overuse of imaging, including CTs and MRIs, for headaches. The measure asked neurologists whether the patient had clinical indications to justify the cost. “This measure gets to the heart of trying to lower costs and finding value in tests,” Dr. Martello said.

While headaches are the leading reason that patients see neurologists, backaches also are common. The work group’s quality measure asks neurologists if they recommended exercise or physical therapy.

The work group also focused on maltreatment screening, a key quality measure for adults 65 and older. However, patients who have neurologic conditions with functional impairment report maltreatment at a higher frequency, according to a study noted in the article. The work group adopted CMS language to cover neurologic patients of all ages.

Advanced care planning was another essential quality measure, in large part because the American Medical Association emphasizes the need for it. “Any physician should be having this discussion with every adult patient,” Dr. Martello said.

Other quality measures included falls outcome and plan of care, medication reconciliation, pain assessment and plan of care, and counseling regarding driving a vehicle.

“You’re creating ways for doctors to improve themselves,” said Dr. Martello. “We constantly review these measures to make sure they’re still applicable — the goal is to better patient care.”

Christiana Care’s work in Parkinson’s disease and other neurological disorders recently received support from the Junior Board of Christiana Care which donated donated $76,000 in proceeds from its 2019 Medicine Ball to benefit  outreach, research and education.