Explore This Lab


Our group recognizes the economic burden associated with neurological conditions and the inefficiency associated with payment for units of service rather than quality and health outcomes. In response, the Massachusetts General Hospital Neuro Value lab was created to increase the value of healthcare in neurology – a ratio of the quality and/or outcomes to cost.

The critical points in this effort are to understand the following: Neuro-psychiatric epidemiology, access to neurological care, appropriateness of care, measures of the processes of care, risk-stratification in chronic neurological conditions, health resources utilization and payment models, impact of new technologies and educational programs, how to systematically gauge outcomes or impact.

These studies should have a positive impact on the health of patients with neurological conditions.

Research Projects

Adherence to Quality Measures: As we begin to move away from this fee-for-service payment method towards a system where the quality of care given is stressed, measures of quality are becoming increasingly important. We are trying to look at how we provide care to patients with chronic neurological conditions and how to better evaluate physicians’ performance.

Disparities in Neurology Care: Our goal is to assess the differences in the quality of care experienced by individuals who have private medical coverage to the individuals who receive public medical coverage. This project stems from the concern that although the Medicaid expansion has increased access to care, there is still a lack of research investigating whether the people receiving this new affordable care are improving in health.

Associations between Quality and Outcomes: Some examples of quality measures in epilepsy are: checking the number of seizures and the amount of issues because of medications. It is expected that the adherence to these quality measures leads to benefits to patients with epilepsy. This project looks at whether or not these quality measures lead to benefits that matter to patients such as fewer convulsions and a better quality of life.

Patient-reported Outcomes in the Neurology Outpatient Setting: Outcomes directly reported by patients are the most efficient, reliable, and valid assessment of health and delivered care. We aim to develop feasible ways to collect and characterize self-reported patient outcomes in the general neurology clinic population. Examples of the measures include socio-demographic information, current medication list and active mental and physical problems.

The Epilepsy Severity Index: This index reflects the clinical complexity of patients with epilepsy and has provided critical information for analysis that requires risk adjustment (severity of illness).  It has been helpful in our concurrent work on quality of care and the impact on outcomes.

Quality of Neurological Care in the Intensive Care Unit: In the Neuro-ICU, utilization of continuous EEG has significantly expanded over the past several years. We aim to understand the application, utilization and safety of continuous EEG monitoring in the Neuro ICU.

Other projects: In several ways, we work in collaboration with other laboratories. Our rich ongoing academic partnerships nourish our aims to integrate medical education, clinical care and research.

Research Positions

Our goal is to enhance research power in health services research field by fostering the career of young investigators that will become international leaders and collaborators.

Apply to current positions at the NeuroValue website.

Selected Publications

We have selected some publications from our lab that are relevant to the topic of health services and outcomes research. The list is not intended to be comprehensive and updated, as our members’ productivity is extremely dynamic.

Identifying Medicare beneficiaries with dementia.
Moura LMVR, Festa N, Price M, Volya M, Benson NM, Zafar S, Weiss M, Blacker D, Normand SL, Newhouse JP, Hsu J. J Am Geriatr Soc. 2021 Apr 26. doi: 10.1111/jgs.17183.

Establishing a learning healthcare system to improve health outcomes for people with epilepsy.
Donahue MA, Herman ST, Dass D, Farrell K, Kukla A, Abend NS, Moura LMVR, Buchhalter JR, Fureman BE. Epilepsy Behav. 2021 Apr;117:107805. doi: 10.1016/j.yebeh.2021.107805.

Patient reported outcomes in ALS: characteristics of the self-entry ALS Functional Rating Scale-revised and the Activities-specific Balance Confidence Scale.
Chew S, Burke KM, Collins E, Church R, Paganoni S, Nicholson K, Babu S, Scalia JB, De Marchi F, Ellrodt AL, Moura LMVR, Chan J, Berry JD. Amyotroph Lateral Scler Frontotemporal Degener. 2021 Mar 26:1-11. doi: 10.1080/21678421.2021.1900259.

Telemedicine Can Support Measurable and High-Quality Epilepsy Care During the COVID-19 Pandemic.
Moura LMVR, Donahue MA, Smith JR, Dass D, Sanches PR, Ayub N, McGraw C, Zafar SF, Cash SS, Hoch DB. Am J Med Qual. 2021 Jan-Feb 01;36(1):5-16. doi: 10.1097/01.JMQ.0000733444.71245.6c.

Patterns of anticonvulsant use and adverse drug events in older adults.
Moura LMVR, Smith JR, Yan Z, Blacker D, Schwamm LH, Newhouse JP, Hernandez-Diaz S, Hsu J. Pharmacoepidemiol Drug Saf. 2021 Jan;30(1):28-36. doi: 10.1002/pds.5139.

Earlier Publications

Accuracy of ICD-10-CM claims-based definitions for epilepsy and seizure type.
Smith JR, Jones FJS, Fureman BE, Buchhalter JR, Herman ST, Ayub N, McGraw C, Cash SS, Hoch DB, Moura LMVR. Epilepsy Res. 2020 Oct;166:106414. doi: 10.1016/j.eplepsyres.2020.106414.

Implementing standardized provider documentation in a tertiary epilepsy clinic.
Jones FJS, Smith JR, Ayub N, Herman ST, Buchhalter JR, Fureman BE, Cash SS, Hoch DB, Moura LMVR. Neurology. 2020 Jul 14;95(2):e213-e223. doi: 10.1212/WNL.0000000000009778.

Patient reported outcome measures (PROMs) in amyotrophic lateral sclerosis.
De Marchi F, Berry JD, Chan J, Caldwell S, Ellrodt A, Scalia J, Burke K, Fang T, Clark Sisodia R, Schwamm LH, Moura LMVR, Paganoni S. J Neurol. 2020 Jun;267(6):1754-1759. doi: 10.1007/s00415-020-09774-8.

A feasibility assessment of functioning and quality-of-life patient-reported outcome measures in adult epilepsy clinics: A systematic review.
Jones FJS, Ezzeddine FL, Herman ST, Buchhalter J, Fureman B, Moura LMVR. Epilepsy Behav. 2020 Jan;102:106704. doi: 10.1016/j.yebeh.2019.106704.

Implementation of quality measures and patient-reported outcomes in an epilepsy clinic.
Moura LMVR, Magliocco B, Ney JP, Cheng EM, Esper GJ, Hoch DB. Neurology. 2019 Nov 26;93(22):e2032-e2041. doi: 10.1212/WNL.0000000000008548.

Epilepsy Among Elderly Medicare Beneficiaries: A Validated Approach to Identify Prevalent and Incident Epilepsy.
Moura LMVR, Smith JR, Blacker D, Vogeli C, Schwamm LH, Cole AJ, Hernandez-Diaz S, Hsu J. Med Care. 2019 Apr;57(4):318-324. doi: 10.1097/MLR.0000000000001072.

Medicare claims can identify post-stroke epilepsy.
Moura LMVR, Smith JR, Blacker D, Vogeli C, Schwamm LH, Hsu J. Epilepsy Res. 2019 Mar;151:40-47. doi: 10.1016/j.eplepsyres.2019.02.002.

Quality improvement in neurology: Epilepsy Quality Measurement Set 2017 update.
Patel AD, Baca C, Franklin G, Herman ST, Hughes I, Meunier L, Moura LMVR, Munger Clary H, Parker-McFadden B, Pugh MJ, Schultz RJ, Spanaki MV, Bennett A, Josephson SA. Neurology. 2018 Oct 30;91(18):829-836. doi: 10.1212/WNL.0000000000006425.

Antiepileptic drug treatment after an unprovoked first seizure: A decision analysis.
Bao EL, Chao LY, Ni P, Moura LMVR, Cole AJ, Cash SS, Hoch DB, Bianchi MT, Westover MB. Neurology. 2018 Oct 9;91(15):e1429-e1439. doi: 10.1212/WNL.0000000000006319.

Performance of Spectrogram-Based Seizure Identification of Adult EEGs by Critical Care Nurses and Neurophysiologists.
Amorim E, Williamson CA, Moura LMVR, Shafi MM, Gaspard N, Rosenthal ES, Guanci MM, Rajajee V, Westover MB. J Clin Neurophysiol. 2017 Jul;34(4):359-364. doi: 10.1097/WNP.0000000000000368.

Accuracy of Limited-Montage Electroencephalography in Monitoring Postanoxic Comatose Patients.
Pati S, McClain L, Moura L, Fan Y, Westover MB. Clin EEG Neurosci. 2017 Nov;48(6):422-427. doi: 10.1177/1550059417715389. Epub 2017 Jun 22.

Accuracy of claims-based algorithms for epilepsy research: Revealing the unseen performance of claims-based studies.
Moura LM, Price M, Cole AJ, Hoch DB, Hsu J. Epilepsia. 2017 Apr;58(4):683-691. doi: 10.1111/epi.13691.

cEEG electrode-related pressure ulcers in acutely hospitalized patients.
Moura LM, Carneiro TS, Kwasnik D, Moura VF Junior, Blodgett CS, Cohen J, McKenna Guanci M, Hoch DB, Hsu J, Cole AJ, Westover MB. Neurol Clin Pract. 2017 Feb;7(1):15-25. doi: 10.1212/CPJ.0000000000000312.

Use of transcranial direct current stimulation for the treatment of auditory hallucinations of schizophrenia - a systematic review.
Pondé PH, de Sena EP, Camprodon JA, de Araújo AN, Neto MF, DiBiasi M, Baptista AF, Moura LM, Cosmo C. Neuropsychiatr Dis Treat. 2017 Feb 1;13:347-355. doi: 10.2147/NDT.S122016.

Burden of illness for super-refractory status epilepticus patients.
Beg JM, Anderson TD, Francis K, Meckley LM, Fitzhenry D, Foster T, Sukhtankar S, Kanes SJ, Moura LM. J Med Econ. 2017 Jan;20(1):45-53. doi: 10.1080/13696998.2016.1223680.

Causal inference as an emerging statistical approach in neurology: an example for epilepsy in the elderly.
Moura LM, Westover MB, Kwasnik D, Cole AJ, Hsu J. Clin Epidemiol. 2016 Dec 30;9:9-18. doi: 10.2147/CLEP.S121023.

Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic.
Moura LM, Schwamm E, Moura Junior V, Seitz MP, Hsu J, Cole AJ, Schwamm LH. Neurology. 2016 Dec 6;87(23):2435-2442. doi: 10.1212/WNL.0000000000003409

Anterior temporal lobectomy for older adults with mesial temporal sclerosis.
Moura LM, Eskandar EN, Hassan M, Salinas J, Cole AJ, Hoch DB, Cash SS, Hsu J. Epilepsy Res. 2016 Nov;127:358-365. doi: 10.1016/j.eplepsyres.2016.09.021.

Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy.
Moura LM, Carneiro TS, Cole AJ, Hsu J, Vickrey BG, Hoch DB. Patient Prefer Adherence. 2016 Oct 31;10:2197-2207. doi: 10.2147/PPA.S119973.

Patient perceptions of physician-documented quality care in epilepsy.
Moura LM, Carneiro TS, Thorn EL, Seitz MP, Hsu J, Cole AJ, Vickrey BG, Hoch DB. Epilepsy Behav. 2016 Sep;62:90-6. doi: 10.1016/j.yebeh.2016.06.024.

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