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  • Measure Summary
  • NQMC:008577
  • Jan 2013

Diagnosis and treatment of headache: percentage of patients with migraine headache seen for migraine in the emergency department/urgent care.

Beithon J, Gallenberg M, Johnson K, Kildahl P, Krenik J, Liebow M, Linbo L, Myers C, Peterson S, Schmidt J, Swanson J. Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jan. 90 p. [140 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2011 Jan. 84 p.

The measure developer reaffirmed the currency of this measure in January 2016.

Primary Measure Domain

Related Health Care Delivery Measures: Use of Services

Secondary Measure Domain

Clinical Quality Measure: Access

Description

This measure is used to assess the percentage of patients age 12 years and older with migraine headache seen for migraine in the emergency department/urgent care.

Rationale

The priority aim addressed by this measure is to increase the percentage of patients with migraine headache who have improvement in their functional status.

Headache is a very common problem presenting to primary care clinicians, with about 3% of emergency department visits and 1.3% of outpatient visits for headaches. While tension-type headache is the most common type of headache overall, migraine is the most common headache type seen in clinical practice, with visits for tension-type headache and cluster headaches being much less common in clinician's offices. Therefore migraine is the first and primary headache type reviewed.

Migraine is a genetically influenced chronic brain condition marked by paroxysmal attacks of moderate to severe throbbing headache. About 324 million persons suffer from migraine worldwide according to the World Health Organization. Nearly 18% of women and 8% of men in the United States suffer from migraine in any given year. Typically the disorder begins in adolescence and young adults but the lifetime cumulative incidence is 43% for women and 18% for men. Over 25% of migraine sufferers have more than three headache days per month.

Because headache is such a common disorder that is often misdiagnosed and undertreated or mistreated, improved diagnosis of headache syndromes will improve the patient's experience of care, notably quality of and satisfaction with care. Morbidity due to headaches is substantial, so improved diagnosis and treatment will improve the health of the population. Reducing office visits, emergency department visits, and inpatient admissions for uncontrolled headache syndromes along with reducing unnecessary tests and procedures for headache diagnosis is likely to reduce total costs of care even if there are more visits for diagnosis of headache and increased costs for headache-specific drugs.

Evidence for Rationale

Beithon J, Gallenberg M, Johnson K, Kildahl P, Krenik J, Liebow M, Linbo L, Myers C, Peterson S, Schmidt J, Swanson J. Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jan. 90 p. [140 references]

Loder E. Triptan therapy in migraine. N Engl J Med. 2010 Jul 1;363(1):63-70. [50 references] PubMed External Web Site Policy

Primary Health Components

Migraine headache

Denominator Description

Number of patients age 12 years and older with migraine headache diagnosis

Numerator Description

Number of patients age 12 years and older and with migraine headache diagnosis who are seen for migraine in the emergency department/urgent care

State of Use

Current routine use

Current Use

Monitoring and planning

Measurement Setting

Ambulatory/Office-based Care

Emergency Department

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 12 years

Target Population Gender

Either male or female

IOM Care Need

Not within an IOM Care Need

IOM Domain

Not within an IOM Domain

Case Finding Period

The time frame pertaining to data collection is monthly.

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of patients age 12 years and older with migraine headache diagnosis

Exclusions
Unspecified

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Number of patients age 12 years and older and with migraine headache diagnosis who are seen for migraine in the emergency department/urgent care

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Does not apply to this measure (i.e., there is no pre-defined preference for the measure score)

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Percentage of patients with migraine headache seen for migraine in the emergency department/urgent care.

Measure Collection Name

Diagnosis and Treatment of Headache

Submitter

Institute for Clinical Systems Improvement - Nonprofit Organization

Developer

Institute for Clinical Systems Improvement - Nonprofit Organization

Funding Source(s)

The Institute for Clinical Systems Improvement's (ICSI's) work is funded by the annual dues of the member medical groups and five sponsoring health plans in Minnesota and Wisconsin.

Composition of the Group that Developed the Measure

Work Group Members: John Beithon, MD (Work Group Leader) (Lakeview Clinic) (Family Medicine); Jane Schmidt, NP (Affiliated Community Medical Center) (Nursing); Pamela Kildahl, RPh (HealthPartners Medical Group and Regions Hospital) (Pharmacy); Julie Krenik, MD (Hutchinson Medical Center) (Family Medicine); Mary Gallenberg, MD (Mayo Clinic) (Gynecology); Mark Liebow, MD (Mayo Clinic) (Internal Medicine); Linda Linbo, RN (Mayo Clinic) (Nursing); Jerry Swanson, MD (Mayo Clinic) (Neurology); Steven Peterson, PT (OSI Physical Therapy) (Physical Therapy); Kari Johnson, RN (Institute for Clinical Systems Improvement) (Clinical Systems Improvement Facilitator); Cassie Myers (Institute for Clinical Systems Improvement) (Clinical Systems Improvement Facilitator)

Financial Disclosures/Other Potential Conflicts of Interest

The Institute for Clinical Systems Improvement (ICSI) has long had a policy of transparency in declaring potential conflicting and competing interests of all individuals who participate in the development, revision and approval of ICSI guidelines and protocols.

In 2010, the ICSI Conflict of Interest Review Committee was established by the Board of Directors to review all disclosures and make recommendations to the board when steps should be taken to mitigate potential conflicts of interest, including recommendations regarding removal of work group members. This committee has adopted the Institute of Medicine Conflict of Interest standards as outlined in the report Clinical Practice Guidelines We Can Trust (2011).

Where there are work group members with identified potential conflicts, these are disclosed and discussed at the initial work group meeting. These members are expected to recuse themselves from related discussions or authorship of related recommendations, as directed by the Conflict of Interest committee or requested by the work group.

The complete ICSI policy regarding Conflicts of Interest is available at the ICSI Web site External Web Site Policy.

Disclosure of Potential Conflicts of Interest

John Beithon, MD (Work Group Leader)
Physician, Family Medicine, Lakeview Clinic
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: Spouse owns Pfizer stock from employer

Mary Gallenberg, MD (Work Group Member)
Physician, Gynecology, Mayo Clinic
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Pamela Kildahl, RPh (Work Group Member)
Pharmacist, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Julie Krenik, MD (Work Group Member)
Medical Director, Family Medicine, Hutchinson Medical Center
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Mark Liebow, MD (Work Group Member)
Medical Consultant, Internal Medicine, Mayo Clinic
National, Regional, Local Committee Affiliations: Employer receives program support from a National Institute of Health grant for ovarian cancer research. Mark is also a chair for senate district 26 DFL Government Council, and a member of the American College of Physicians, MN Chapter
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Linda Linbo, RN (Work Group Member)
Neurology, Mayo Clinic
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Steven Peterson, PT (Work Group Member)
Clinic Manager, Physical Therapy, OSI Physical Therapy
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: ICSI Adult Acute and Subacute Low Back Pain Guideline Work Group
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Jane Schmidt, NP (Work Group Member)
Nurse Practitioner, Family Medicine, Affiliated Community Medical Center
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Jerry Swanson, MD (Work Group Member)
Consultant and Chair of Headache Division, Neurology, Mayo Clinic
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: Receives compensation from UpToDate as a headache document editor

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2013 Jan

Measure Maintenance

Scientific documents are revised every 12 to 24 months as indicated by changes in clinical practice and literature.

Date of Next Anticipated Revision

The next scheduled revision will occur within 24 months.

Measure Status

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2011 Jan. 84 p.

The measure developer reaffirmed the currency of this measure in January 2016.

Source(s)

Beithon J, Gallenberg M, Johnson K, Kildahl P, Krenik J, Liebow M, Linbo L, Myers C, Peterson S, Schmidt J, Swanson J. Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jan. 90 p. [140 references]

Measure Availability

Source available for purchase from the Institute for Clinical Systems Improvement (ICSI) Web site External Web Site Policy. Also available to ICSI members for free at the ICSI Web site External Web Site Policy and to Minnesota health care organizations free by request at the ICSI Web site External Web Site Policy.

For more information, contact ICSI at 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; Phone: 952-814-7060; Fax: 952-858-9675; Web site: www.icsi.org External Web Site Policy; E-mail: icsi.info@icsi.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on March 19, 2012.

This NQMC summary was updated by ECRI Institute on August 12, 2013.

The information was reaffirmed by the measure developer on January 13, 2016.

Copyright Statement

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.

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NGC GUIDELINE SUMMARIES

  • NGC:009625
  • 1998 Aug (revised 2013 Jan)

Diagnosis and treatment of headache.


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