The Axon Registry® is the neurology-specific quality improvement clinical data registry of the American Academy of Neurology (AAN). The vision of the Axon Registry is to provide neurologists with a tool to measure and improve the quality of care and patient outcomes. The Axon Registry provides neurologists with neurologyspecific quality measures, instead of generic, nonspecialty-specific quality measures, for more meaningful data to improve patient outcomes and manage resources. The registry was launched in 2016 as a free benefit to US AAN members practicing in outpatient clinical settings. The Axon Registry began with 25 quality measures in 2016 and now offers 49 quality measures for registry participants. In 2022, the Axon Registry plans to integrate quality measures across 15 subspecialties and will introduce for the first time stroke quality measures. This growth allows participants to identify gaps in care and make improvements across several disease states.
In addition to providing a tool for quality improvement, the Axon Registry allows participants to meet regulatory and certification requirements. Since 2016, the Centers for Medicare & Medicaid Services has designated the Axon Registry a qualified clinical data registry (QCDR) and participants can earn continuing certification for the Maintenance of Certification Program’s Improvement in Practice (Part IV) clinical activity from the American Board of Psychiatry and Neurology.
The 2022 Axon Registry Annual Report provides a fundamental understanding of the data within the Axon Registry, with further analysis on the practices, participants and patients included in the registry. We also analyze quality measures which are utilized by at least 50 registry participants.
Only de-identified registry data was used to produce this Axon Registry Annual Report. The AAN is committed to transparent, compliant, secure, and responsible governance of the Axon Registry. The Academy and our registry vendors comply with the laws and regulations applicable to the Axon Registry and have adopted HIPAA Privacy Policies and Procedures. The collection, use, disclosure, and stewardship of Axon Registry data is described in more detail in the Academy’s Data Governance Policy found here
Note: All data in this report are as of February 2022, with the exception of the practice type data and measure performance data, which are as of May 2022.
The Axon Registry is one tool in the AAN’s quality cycle, depicted below. The data within the registry informs guideline development, which informs quality measure development, which in turn informs which quality measures are integrated into the registry.
(Total Encounters by Year) Encounter Definition: For all tables below, clinical encounters are patient/provider visits that include an Evaluation & Management (E/M) code. Only includes patients with condition (diagnosis) codes and condition documentation dates before or on the encounter date.
An encounter is classified as office if it has code 99201-99215 without modifier 95 or code 99241-99245 without modifier 95. An encounter is classified as telehealth if it has code 99441-99443 or codes 99201-99215 with modifier 95 or 99241-99245 with modifier 95. *Shift to telehealth due to COVID-19 Public Health Emergency.
Note: This may not capture all telehealth encounters since some telehealth encounters were coded as office visits during the pandemic.
*Shift to telehealth due to COVID-19 Public Health Emergency.
Solo Group
Multi-Specialty Group
Academic Medical Center Hospital, University, Health System
Solo Group
Multi-Specialty Group Academic Medical Center Hospital, University, Health System
QUALITY MEASURE PERFORMANCE
Measure Measure Title*
Axon 04 Parkinson’s Disease: Assessment of Mood and Psychosis for Patients with Parkinson’s Disease
Axon 06.1 Querying and Follow-up About Symptoms Assessment of Autonomic Dysfunction for Patients with Parkinson’s Disease
# Practices
# Providers Registry Average
38 160 33.5
71 328 65.34
Axon 13 Medication Prescribed for Acute Migraine Attack 127 608 68.48
Axon 17 Documentation of Current Medications in the Medical Record
136 729 88.19
Axon 18 Advance Care Plan 116 491 40.87
Axon 22.1 Overuse of Imaging for the Evaluation of Primary Headache *inverse measure
Axon 23 Exercise and Appropriate Physical Activity Counseling for Patients with MS
Axon 27 Assessment of Cognitive Impairment or Dysfunction for Patients with Parkinson’s Disease
Axon 29 Rehabilitative Therapy Referral for Patients with Parkinson’s Disease
69 385 17.63
101 462 75.64
37 187 26.53
46 211 45.06
9 56 17.26
Measure
Axon 46
Pediatric Medication Reconciliation 31 198 67.05
Axon 48 Activity Counseling For Back Pain 8 57 7.69
Axon 52_1
Axon 52_3
Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling
Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling
Axon 60 Sleep Apnea: Severity Assessment at Initial Diagnosis
21 59 33.88
22 60 34.42
8 81 13.05
Axon 64_1 Patient Reported Falls and Plan of Care 57 325 2.02
Axon 68 Acute Treatment Prescribed for Cluster Headache 9 69 32.54
Wilson, M.A., Benish, S.M., McCarthy, L., Romano, J.G., Lundgren, K., Byrne, M., Schierman, B., Jones, Jr., L.K. (2021). Quality of Neurologic Care in the United States: Initial Report from the Axon Registry, Neurology.
Victorio, C.C., Lundgren, K., Johnston-Gross, M., Bennett, A., Magliocco, B., Deshpande, A., Jones, Jr., L.K. (2020). Implementation of a Data Accuracy Plan to Improve Data Extraction Yield in the Axon Registry. Neurology.
Baca, C.M., MD, Benish, S., Videnovic, A., Lundgren, K., Magliocco, B., Schierman, B., Palmer, L., Jones, Jr., L.K. (2019). Axon Registry data validation: Accuracy assessment of data extraction and measure specification. Neurology.
Patel, A., Fritz, J.V., Evans, D., Lundgren, K.B., Hentges, K., Jones, Jr., L.K. (2018). Utilizing the Axon Registry for quality improvement. Neurology.
Butcher, L. (2016) AAN Launches Axon Registry to Enable Compliance with Neurology-specific Quality Measures: Feedback from Early Adopters. Neurology Today.
Sigsbee, B., Goldenberg, J.N., Bever, Jr., C.T., Schierman, B.,Jones, Jr., L.K. (2016). Introducing the Axon Registry: An opportunity to improve quality of neurologic care. Neurology.
Busis, N.A., Franklin, G.M., (2016). The AAN’s Axon Registry: Mastering how we are measured. Neurology.
Maraganore, D., Frigerio, R., Kazmi, N., Meyers, S.L., Sefa, M., Walters, S.A., Silverstein, J.C. (2015). Quality improvement and practice-based research in neurology using the electronic medical record. Neurology.
Goldenberg, J.A. (2015). The breadth and burden of data collection in clinical practice. Neurology.
Sigsbee, B., Bever, Jr., C.T., Jones, Jr., L.K. (2015). Practice improvement requires more than guidelines and quality measures. Neurology.
Chair
Sarah M. Benish, MD, FAAN
Vice Chair
Andrew M. Wilson, MD, MS, MBA
Christine B. Baca, MD, FAAN
Susan T. Herman, MD, FAAN
Neeta Garg, MD
Allison L. Weathers, MD, FAAN
Cristina Victorio, MD
Mandip Singh Dhamoon, MD, MPH
Tammy Thu Ann Pham, MD
Marcella Marolf Mwaisela, MD
Justin P. Martello, MD
William H. Fleming, III, MD, FAAN
Kirk Roberts, MD, FAAN
Glenn D. Graham, MD, PhD, FAAN
John Safa Khoury, MD
Richard T. Benson, MD, PhD, FAAN
Waimei Amy Tai, MD, FAAN
Becky A. Schierman, MPH
Karen Lundgren, MBA Jesus Barrera, MHA
Esther Ndemo, MHI Aristotle Mante, PhD
Ellen Anderson-benge, MS
