Dr. Kvam is a board-certified neurologist and fellowship-trained neurohospitalist, specializing in the care of patients with a variety of acute neurological disorders including headache, epilepsy, Guillain-Barre, myasthenia gravis, encephalitis, multiple sclerosis and other neuroinflammatory diseases as well as neurologic complications of systemic disease.
She is the founding director of the Stanford Neurohospitalist Program and spends most of her time attending on the neurohospitalist ward and consult services. She is actively involved in teaching medical students, residents and fellows. Dr. Kvam founded and continues to co-direct the novel Neurology Resident Quality Improvement Curriculum and has led a number of quality improvement initiatives on the inpatient neurology service. Her research interests include improving the quality and value of care for hospitalized neurology patients, transitions of care, encephalitis, and resident and interprofessional education.
For more information about our Stanford Neurohospitalist Program, please visit our website: https://med.stanford.edu/neurology/divisions/neurohospitalist.html
Director, Stanford Neurohospitalist Program (2014 - Present)
Honors & Awards
Lysia K. Forno Award for Excellence in Teaching Neurology Residents, Stanford Department of Neurology (2018)
Excellence in Neurology Clerkship Teaching Award, Stanford Department of Neurology (2018)
Excellence in Neurology Clerkship Teaching Award, Stanford Department of Neurology (2017)
Excellence in Neurology Clerkship Teaching Award, Stanford Department of Neurology (2015)
Boards, Advisory Committees, Professional Organizations
Editorial Board Member, The Neurohospitalist (2016 - Present)
Elected Member, AAN Evidence Based Quality Measures Committee (2018 - Present)
Elected Member, AAN ALS Quality Measures Workgroup (2021 - Present)
Invited Member, International Encephalitis Consortium (2014 - Present)
Member, Neurology Resident Clinical Competencies Committee (2017 - Present)
Member, Stanford Neurology Professional Practice Evaluation Committee (2014 - Present)
Member, Neurohospitalist Fellowship Consortium (2018 - Present)
Member, Neurology Clinical Affairs Advisory Committee (2019 - Present)
Member, Neurology Quality Council (2017 - Present)
Member, Neurosciences Service Line Committee (2014 - Present)
Member, Stanford Neurology Education Committee (2015 - Present)
Chair, H1 Unit RN-MD Committee (2016 - 2018)
Member, American Academy of Neurology (2010 - Present)
Member, Society of Hospital Medicine (2016 - Present)
Member, Neurohospitalist Society (2013 - Present)
Board Certification, American Board of Psychiatry & Neurology (2013)
Fellowship, University of California, San Francisco, Neurohospitalist (2014)
Residency, University of California, San Francisco, Neurology (2013)
Internship, St. Joseph Mercy Medical Center, Internal Medicine (2010)
MD, University of Michigan (2009)
B.S. Economics, University of Pennsylvania, Health Care Management & Chemistry (2002)
Community and International Work
English Teacher, Mongolia
Opportunities for Student Involvement
Current Research and Scholarly Interests
Dr. Kvam's research focuses on 1) how to measure quality of care for patients with neurologic disease, 2) the value and impact of neurohospitalist models of care on patient outcomes and trainee education and 3) outcomes in rare diseases like autoimmune encephalitis.
Quality Improvement Metrics and Methods for Neurohospitalists.
2022; 40 (1): 211-230
Measurement of clinical performance is largely driven by the requirements of the Centers for Medicare and Medicaid Services and accrediting bodies like The Joint Commission. Performance measures include length of stay, readmission rate, mortality rate, hospital-acquired complications, and stroke core measures. Hospital rankings also depend heavily on quality and patient safety indicators. Becoming facile with these measures can aid neurohospitalists in understanding their value and garnering resources to support improvement projects. Neurohospitalists can apply a structured A3-based method to define a clinical problem, perform systematic analysis, then design and test solutions to drive improved outcomes for patients with neurologic disease.
View details for DOI 10.1016/j.ncl.2021.08.011
View details for PubMedID 34798971
Education Research: A novel resident-driven neurology quality improvement curriculum.
2020; 94 (3): 137–42
OBJECTIVE: To describe and assess the effectiveness of a neurology resident quality improvement curriculum focused on development of practical skills and project experience.METHODS: We designed and implemented a quality improvement curriculum composed of (1) a workshop series and (2) monthly resident-led Morbidity, Mortality, & Improvement conferences focused on case analysis and project development. Surveys were administered precurriculum and 18 months postcurriculum to assess the effect on self-assessed confidence with quality improvement skills, attitudes, and project participation. Scholarship in the form of posters, presentations, and manuscripts was tracked during the course of the study.RESULTS: Precurriculum, 83% of neurology residents felt that instruction in quality improvement was important, but most rated their confidence level with various skills as low. Following implementation of the curriculum, residents were significantly more confident in analyzing a patient case (odds ratio, 95% confidence interval) (2.4, 1.9-3.1), proposing system changes (3.1, 2.3-3.9), writing a problem statement (9.9, 6.2-13.5), studying a process (3.1, 2.3-3.8), identifying resources (3.1, 2.3-3.8), identifying appropriate measures (2.5, 1.9-3.0), collaborating with other providers to make improvements (4.9, 3.5-6.4), and making changes in a system (3.1, 2.3-3.8). Project participation increased from the precurriculum baseline (7/18, 39%) to the postcurriculum period (17/22, 77%; p = 0.023). One hundred percent of residents surveyed rated the curriculum positively.CONCLUSIONS: Our multifaceted curriculum was associated with increased resident confidence with quality improvement skills and increased participation in improvement projects. With adequate faculty mentorship, this curriculum represents a novel template for preparing neurology residents for meeting the expectations of improvement in practice and offers scholarship opportunities.
View details for DOI 10.1212/WNL.0000000000008752
View details for PubMedID 31959682
- Evaluation of the impact of a neurohospitalist program at an academic medical center Neurohospitalist Society 2020
Emergent neuroimaging for seizures in epilepsy: A population study.
Epilepsy & behavior : E&B
2020; 112: 107339
We determined how often patients with epilepsy presented to the emergency department (ED) for seizure and the frequency and predictors for undergoing emergent neuroimaging during those visits. We conducted a retrospective population-based cohort study using administrative claims' data from 2007 to 2015. Adults with epilepsy were identified based on a diagnosis of epilepsy and an outpatient prescription for an antiepileptic medication. The Bonferroni corrected significance level was 0.0018. We identified 381,362 patients with a mean follow-up period of 1.99 years, of whom 35,015 (9.2%) patients presented to the ED for seizure at least once. Patients with at least one ED visit were younger, more likely to be male, had fewer comorbidities, and had longer follow-up as compared with those with no ED visit (all p < 0.001). Among the 35,015 patients presenting to the ED, 13.6% had neuroimaging, mostly commonly head computed tomography (CT; 95.5%). Patients undergoing neuroimaging were younger (46 versus 48 years) and with higher rates of psychosis (17.4% versus 13.8%) and depression (16.1% versus 12.2%; p < 0.001). This helps to quantify the burden of ED and emergent neuroimaging utilization for patients with epilepsy and can help inform efforts to curtail unnecessary neuroimaging.
View details for DOI 10.1016/j.yebeh.2020.107339
View details for PubMedID 32911297
- A Case of Progressive Myelopathy in a Middle-aged Woman. JAMA neurology 2019
Yield of Emergent CT in Patients With Epilepsy Presenting With a Seizure
2019; 9 (2): 71–78
Studies of emergent neuroimaging in the management of patients presenting with a breakthrough seizure are lacking. We sought to determine how often emergent computed tomography (CT) scans are obtained in patients with known epilepsy presenting with a seizure and how often acute abnormalities are found.This multicenter retrospective cohort study was performed in the emergency department at 2 academic medical centers. The primary outcomes were percentage of visits where a CT scan was obtained, whether CT findings represented acute abnormalities, and whether these findings changed acute management.Of the 396 visits included, CT scans were obtained in 39%, and 8% of these scans demonstrated acute abnormalities. Patients who were older, had status epilepticus, a brain tumor, head trauma, or an abnormal examination were all significantly more likely to undergo acute neuroimaging (P < .05). In the multivariable model, only history of brain tumor (odds ratio [OR] 5.88, 95% confidence interval [CI], 1.33-26.1) and head trauma as a result of seizure (OR 3.92, 95% CI, 1.01-15.2) reached statistical significance in predicting an acutely abnormal scan. The likelihood of an acute imaging abnormality in visits for patients without a history of brain tumor or head trauma as a result of the seizure was 2.7% (2 visits). Both of these patients had abnormal neurological examinations.Obtaining an emergent CT scan for patients with epilepsy presenting with a seizure may be avoidable in most cases, but might be indicated for patients with a history of brain tumor or head trauma as a result of seizure.
View details for PubMedID 30915184
View details for PubMedCentralID PMC6429671
A Quality Improvement Curriculum for Neurology Residents
LIPPINCOTT WILLIAMS & WILKINS. 2018
View details for Web of Science ID 000453090805218
A case of progressive multifocal leukoencephalopathy in a lupus patient treated with belimumab
2014; 23 (7): 711-713
Belimumab is a monoclonal antibody against soluble B-lymphocyte stimulator, an essential growth factor for B-cell maturation and activation, which was approved by the US FDA in 2011 for patients with active autoantibody-positive systemic lupus erythematosus (SLE) who have failed standard treatment. Here we present the case of a 40-year-old woman with SLE diagnosed with progressive multifocal leukoencephalopathy (PML) on belimumab. After a total of 10 infusions of belimumab, from August 2012 through April 2013, in April 2013 she developed progressive neurologic decline with episodic dystonia and autonomic symptoms. Her imaging showed multifocal, confluent regions of T2 hyperintensity in the white matter bilaterally, and CSF JCV PCR returned positive. Based on the patient's clinically mild SLE and the timing of symptom onset, belimumab likely played a key role in the development of PML. Trials of belimumab for other autoimmune diseases are ongoing; as applications for this novel drug broaden, careful monitoring for this potentially fatal adverse effect is warranted.
View details for DOI 10.1177/0961203314524292
View details for Web of Science ID 000339103900015
View details for PubMedID 24531080
Sedation with nitrous oxide compared with no sedation during catheterization for urologic imaging in children.
2007; 37 (7): 678–84
Various strategies to mitigate children's distress during voiding cystourethrography (VCUG) have been described. Sedation with nitrous oxide is comparable to that with oral midazolam for VCUG, but a side-by-side comparison of nitrous oxide sedation and routine care is lacking.The effects of sedation/analgesia using 70% nitrous oxide and routine care for VCUG and radionuclide cystography (RNC) were compared.A sample of 204 children 4-18 years of age scheduled for VCUG or RNC with sedation or routine care were enrolled in this prospective study. Nitrous oxide/oxygen (70%/30%) was administered during urethral catheterization to children in the sedated group. The outcomes recorded included observed distress using the Brief Behavioral Distress Score, self-reported pain, and time in department.The study included 204 patients (99 nonsedated, 105 sedated) with a median age of 6.3 years (range 4.0-15.2 years). Distress and pain scores were greater in nonsedated than in sedated patients (P < 0.001). Time in department was longer in the sedated group (90 min vs. 30 min); however, time from entry to catheterization in a non-imaging area accounted for most of the difference. There was no difference in radiologic imaging time.Sedation with nitrous oxide is effective in reducing distress and pain during catheterization for VCUG or RNC in children.
View details for DOI 10.1007/s00247-007-0508-z
View details for PubMedID 17564739