Rationale: The purpose of this study was to assess the application of the recently developed 8 epilepsy quality metrics in a primarily rural and Appalachian system of clinics conducted at the Kentucky (CCHCN).

Methods: Retrospective review of clinical charts from the CCSHCN between November 2013 to January 2013. Measures assessed were: seizure type and frequency, epilepsy etiology or syndrome, electroencephalogram (EEG), brain imaging, antiepileptic drug side effects, surgery referral, safety counseling, folic acid supplementation, and counseling of childbearing potential patients.

Results: We identified 81 children with epilepsy; aged 1 to 21 yo (mean age 9.6 years) 46 males and 35 females. The seizure type and frequency were addressed in 98.8%. Epilepsy etiology or syndrome in 96.3%. EEG reviewed or requested in 97.5%. Brain imaging was reviewed or requested in 79%. Antiepileptic drug side effects were addressed in 59.3%. Epilepsy surgery evaluation and referral was 3.7% of the 23 patients with drug resistant epilepsy. Documentation regarding safety counseling was 25% of patients. Of the 19 patients with childbearing potential counseling was documented in 40% and folic acid supplementation was addressed in 33%.

Conclusion: In this study, a sub-set of quality measures had a high rate of compliance. For other measures with lower rates of compliance it is unclear if the measures, as currently formulated, are appropriate for pediatric clinics. While charts routinely included information about child educational status, it is not included in the quality guidelines. We suggest that pediatric clinics require a revised sub-set of quality guidelines for epilepsy.