MEASURE #10: PLAN OF CARE FOR MIGRAINE OR CERVICOGENIC HEADACHE DEVELOPED OR REVIEWED Headache

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1 MEASURE #10: PLAN OF CARE FOR MIGRAINE OR CERVICOGENIC HEADACHE DEVELOPED OR REVIEWED Headache Measure Descriptin All patients diagnsed with migraine headache r cervicgenic headache wh had a headache management plan f care develped r reviewed at least nce during the 12 mnth measurement perid. Measure Cmpnents Numeratr Statement Patients wh had a headache management plan f care fr migraine headache r cervicgenic headache* develped r reviewed by the clinician at least nce during the 12 mnth measurement perid. Statement Exceptins Supprting Guideline & Other References *Headache management plan f care may include: gals fr headache management (e.g., reduced number f days f migraine per mnth, reduce severity f headache), a plan fr acute migraine medicatins, preventive migraine medicatins, nn-pharmaclgical ptins (e.g., trigger management, stress reductin, physical therapy), cmmunicatin between prviders, referral t a headache specialist r ther relevant items. All patients diagnsed with migraine headache r cervicgenic headache. Exceptins: Medical exceptins fr nt develping r reviewing a plan f care fr migraine r cervicgenic headache (i.e., patient is cgnitively impaired, cannt cmmunicate and n caregiver is available) The fllwing clinical recmmendatin statements are quted verbatim frm the referenced clinical guidelines r evidence papers and represent the evidence base fr the measure: Develp a written headache treatment plan fr preventin and management f acute migraine t: Decrease headache frequency (aim fr fewer than 5 headache days per mnth). Decrease headache severity (headaches will respnd quickly t an abrtive therapy). Avid medicatin/caffeine veruse headache (see treatment: medicatin veruse headaches). Lifestyle mdificatins/nn-pharmaclgic ptins: Prvide selfmanagement educatin. Teach and encurage patients t maintain a healthy lifestyle (prper nutritin, regular physical activity, adequate sleep, and stress reductin strategies). Identify and avid triggers (e.g., tbacc smke, strng drs, r sprays). Address wrkplace ergnmics (attentin t wrkplace ergnmics and instructin in self-care f neck tensin can have a dramatic effect n headache frequency). Pharmaclgic ptins: The chice f acute migraine treatments shuld be dictated by the rapidity f nset, headache severity, assciated symptms (e.g., nausea/vmiting), and patient preference (N strength f evidence. gal). 1 Include the fllwing in discussins with the persn with a headache disrder: a psitive diagnsis, including an explanatin f the diagnsis and reassurance that American Academy f Neurlgy. All Rights Reserved. 69

2 ther pathlgy has been excluded and the ptins fr management and recgnitin that headache is a valid medical disrder that can have a significant impact n the persn and their family r caregivers. (N strength f evidence; age12 years ld and lder) 2 A cmprehensive therapy plan shuld encmpass the whle patient, via a patientphysician partnership where gals and strategies are mutually established. Key treatments include nndrug appraches, such as educatin and lifestyle mdificatins, t reduce the ccurrence f attacks, as well as acute medicatins t address the immediate need fr relief during an attack. 3 A cmprehensive migraine management plan invlves a partnership between the patient and healthcare prfessinal where treatment gals and strategies are established. Elements f such a plan shuld include preventive strategies t reduce the frequency and effects f future attacks as well as the use f acute treatments t address the immediate need fr relief during an attack. Appraches t preventin include educatin, lifestyle mdificatin, and, ften, apprpriate medicatin. 1 GrupHealth Migraine and Tensin Headache Diagnsis and Treatment Guideline NICE Headaches: Diagnsis and management f headaches in yung peple and adults. Natinal Clinical Guideline Centre n behalf f the Natinal Institute fr Health and Clinical Excellence (NICE) September 2012; NICE clinical guideline Diamnd ML, Wenzel RG, Nissan GR. Optimizing migraine therapy: evidence-based and patient-centered care. Expert Rev Neurther Jun;6(6): Diamnd M, Cady R. Initiating and ptimizing acute therapy fr migraine: the rle f patient-centered stratified care. Am J Med Mar;118 Suppl 1:18S-27S Ratinale Optimizing headache management requires a systematic assessment f symptms, including the develpment f an individualized plan f care. Clinicians are advised t base their treatment chice n degree f disability alng with attack frequency and duratin, nnheadache symptms, patient preference, and prir histry f treatment respnse, using a stratified apprach t care. 1 This infrmatin shuld be included in the patient s plan f care. HRQL and disability are psitively impacted by treatment interventins and a cntinuity f care. 1 Gap in Care It is critical that patients have a successful plan f care fr migraine r cervicgenic headaches. This plan f care may include the use f acute and/r prphylactic medicatins, behavir management, patient preferences, histry f respnse t medicatin, and headache severity. Evidence als suggests that persn and scietal csts f headache disrders are likely t be reduced when headache patients receive apprpriate treatment and when a cntinuity f care is ffered. 2 Opprtunity fr Imprvement There is a ntewrthy need t imprve care crdinatin and patient engagement in the management f migraine and cervicgenic headaches thrugh the creatin and use f a headache care plan. Creating and implementing a plan f care can increase quality f life by reducing headache severity r duratin f headaches, decrease disability, imprve patient satisfactin with care, and decrease csts frm inapprpriate medicatins and/r diagnstic tests American Academy f Neurlgy. All Rights Reserved. 70

3 1D Amic D, Grazzi L, Usai S, Lenardi M. Disability and quality f life in headache: where are we nt and where we are heading. Neurl Sci 2013; 34(S1):S1-S5 2Smith TR, Nichlsn RA, Banks JW. Migraine educatin imprves quality f life in primary care setting. Headache. 2010; 50: Measure Designatin Measure purpse Type f measure Level f Measurement Care setting Data surce Quality imprvement Accuntability Prcess Ppulatin r System Level Outpatient visits Electrnic health recrd (EHR) data Administrative Data/Claims (inpatient r utpatient claims) Administrative Data/Claims Expanded (multiple-surce) Paper medical recrd Technical Specificatins: Administrative/Claims Data Administrative claims data cllectin requires users t identify the eligible ppulatin (denminatr) and numeratr using cdes recrded n claims r billing frms (electrnic r paper). Users reprt a rate based n all patients in a given practice fr whm data are available and wh meet the eligible denminatr criteria. The specificatins listed belw are thse needed fr perfrmance calculatin. (Eligible Ppulatin) ICD-9 and ICD-10 Diagnsis Cdes: ICD Migraine with aura Migraine withut aura Variants f migraine ICD-10 G43.109, Migraine with aura, nt intractable, withut G43.119, Migraine with aura, intractable, withut G43.101, Migraine with aura, nt intractable, with G43.111, Migraine with aura, intractable, with G Migraine withut aura, nt intractable, withut G Migraine withut aura, intractable, withut G43.001, Migraine withut aura, nt intractable, with G43.011, Migraine withut aura, intractable with G43.809, Other migraine, nt intractable withut G Other migraine, intractable, withut G43.801, Other migraine, nt intractable, with G43.811, Other migraine, intractable, American Academy f Neurlgy. All Rights Reserved. 71

4 346.4 Menstrual Migraine Persistent Migraine Persistent Migraine aura with cerebral infarctin Chrnic migraine withut aura Other frms f migraine with G Menstrual migraine nt intractable, withut status migrainus G Menstrual migraine intractable withut G Menstrual migraine nt intractable with G Menstrual migraine intractable with G Persistent migraine aura withut cerebral infarctin, nt intractable, withut G Persistent migraine aura withut cerebral infarctin intractable withut G Persistent migraine aura withut cerebral infarctin nt intractable with G Persistent migraine aura withut cerebral infarctin intractable with G Persistent migraine aura with cerebral infarctin, nt intractable, withut G Persistent migraine aura with cerebral infarctin, intractable, withut G Persistent migraine aura with cerebral infarctin, nt intractable with G Persistent migraine aura with cerebral infarctin, intractable, with status migrainsus G Chrnic migraine withut aura, nt intractable, withut G Chrnic migraine withut aura, intractable, withut G Chrnic migraine withut aura, nt intractable, with G Chrnic migraine withut aura, intractable, with G Other migraine, nt intractable, withut G Other migraine intractable withut G Other migraine nt intractable with G Other migraine intractable with status migrainsus American Academy f Neurlgy. All Rights Reserved. 72

5 346.9 Migraine unspecified G Migraine unspecified nt intractable withut G Migraine unspecified intractable withut G Migraine unspecified nt intractable with G Migraine unspecified intractable with AND CPT Evaluatin and Management Service Cdes: Outpatient: , (Office r ther utpatient visit-new Patient); (Office r ther utpatient visit-established Patient); (Office r Other Outpatient Cnsultatin-New r Established Patient); American Academy f Neurlgy. All Rights Reserved. 73

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