Importance of Measuring Quality of Neurologic Care: Axon Registry Highlights

Doctors Examining X-Ray
Researchers sought to assess US neurologic quality of care performance using the 2019 Axon Registry data and identify what provider traits and other factors may influence measure performance.

Quality of neurologic care from the Axon Registry, a platform that helps its members measure, improve, and report clinical neurology quality measure, shows modest performance scores and variability in its measures and providers, according to study results published in Neurology.

In 2015, the American Academy of Neurology launched the Axon Registry Qualified Clinical Data Registry in order to collect data on quality of care and determine areas which need improving.

The objective of the current study was to provide a baseline assessment of quality of neurologic care in the US using the 2019 Axon Registry to provide insights on its measures and identify opportunities to improve neurologic care for patients.

The investigators selected 20 of the 49 quality measures collected in the Axon Registry and assessed the quality for each measure on the basis of provider (n=1023) and variance over time (2015-2019 vs 2019). Performance scores ranged from 0-100 and were calculated by dividing the number of patients meeting the quality criterion by the total number of eligible patients and multiplied by 100.

Among all providers, 93% were included in both the historical and 2019 only cohorts. Providers were distributed in the South (34%), Midwest (31%), Northeast (19%), and West (15%) and worked in practices with >30 providers (53%), <10 providers (29%), or 10-30 providers (18%).

There were 18,126,212 encounters in the historical dataset and 2,340,963 during 2019 alone. The patient populations were skewed toward older (³65 years) White women and patients who were seeking care for migraine or headache, epilepsy, neuropathy, multiple sclerosis, cognitive impairment, Parkinson disease, and sleep disorders.

A total of 3 measures performed well (>90%) and 10 poorly (<10%).

Excluding poor performing providers (score of 0), 6 features were in the highest and 2 in the lowest deciles. The average score for providers was 66 and for measure was 53.

No significant differences were observed for clinical topic or neurological condition (r, 0.1; P =.69), Merit-Based Incentive Payment System status (z, 0.54; P =.59), or practice size (c2, 2.4; P =.31).

Grouping measures into 4 categories based on complexity (discrete order, free text concept, free text multistep, and standardized scale), the average performance ranged from 92 (discrete order) to 15 (standardized scale). The differences due to measure complexity were significant (c2, 1354; P <.0001).

This study may not be generalizable to the neurologic care received by all patients in the US, as only a fraction of providers reported data to the registry.

These data indicated that many measure performance and designs likely need to be amended in order to standardize and improve quality of neurologic care for patients in the US.

“We believe that through thoughtful measure development, precise mapping of [electronic health records] EHR data, and proper clinical documentation, the Axon Registry will continue to be an invaluable tool to improve and report clinical neurology quality measures,” the researchers concluded.


Wilson AM, Benish SM, McCarthy L, et al. Quality of Neurologic Care in the United States: Initial Report From the Axon Registry. Neurology. Published online August 17, 2021. doi:10.1212/WNL.0000000000012378