To establish the first systems level continuous quality improvement (CQI) collaborative for multiple sclerosis (MS) in the United States, to conduct benchmarking analyses and assessments of geographic variation in MS care quality and value, and study the effect of CQI interventions on improvement of selected performance (quality) indicators.
This is a three year study which employed a step-wedge randomized design which exposed three of four participating centers to a healthcare QI intervention during the 3 year period. Each of the centers exposed to an intervention served as its own control during a baseline pre-intervention period during the first year of the study. The fourth site served as a longitudinal control for comparison to the other three centers exposed to a QI intervention.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
694
Randomly selected sites will receive one of two system level improvement approaches; 1) patient centered specialty medical home certification 2) IHI Breakthrough Series improvement approach with professional improvement coaching.
Neurology Associates of Greater Orlando
Maitland, Florida, United States
Massachusetts General Hospital Multiple Sclerosis Center
Boston, Massachusetts, United States
Concord Hospital
Concord, New Hampshire, United States
University of Vermont Multiple Sclerosis Center
Burlington, Vermont, United States
Disease modifying therapy utilization
The percentage of eligible MS patients on disease modifying therapy (DMT access), which is operationally defined as the total number of eligible patients on DMT/the total number of patients seen per quarter at a participating center for whom DMT is an appropriate treatment option.
Time frame: every 12 weeks for a period of 36 months
Clinical outcome for Depression
patient reported outcome of The Effects of Your MS (PHQ-9)
Time frame: every 12 weeks for a period of 36 months
Clinic Outcome for Anxiety
patient reported outcome of Neuro-QOL: Anxiety survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes on Cognitive Function
patient reported outcome of Neuro-QOL: Cognitive Function survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes on mobility
patient reported outcome of Neuro-QOL: Lower Extremity Function (Mobility) survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes on fine motor skills and activities of daily living
patient reported outcome of Neuro-QOL: Upper Extremity Function (Fine Motor, ADL) survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes on stigma associated with MS
patient reported outcome of Neuro-QOL: Stigma survey
Time frame: every 12 weeks for a period of 36 months
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Clinic Outcomes on ability to participate in social roles and activities
patient reported outcome of Neuro-QOL: Ability to Participate in Social Roles and Activities survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes on satisfaction with social roles and activities
patient reported outcome of Neuro-QOL: Satisfaction with Social Roles and Activities survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes for sleep disturbance
patient reported outcome of Neuro-QOL: Sleep Disturbance survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes for communication
patient reported outcome of Neuro-QOL: Communication survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes for Vitamin D levels in MS patients
patient reported outcome of Vitamin D Level survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes for fatigue
patient reported outcome of PROMIS Fatigue MS survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes for assesment of patient health status
patient reported outcome of Brief Appraisal Inventory survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes for satisfaction of treatment by medication
patient reported outcome of Treatment Satisfaction Questionnaire for Medication (TSQM-9) survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes for the effects of MS on the patient
patient reported outcome of The Effects of Your MS (PDDS) survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes for the presence of a MS relapse
patient reported outcome of My MS Relapse Evaluation survey
Time frame: every 12 weeks for a period of 36 months
Clinic Outcomes reporting of MS patient daily symptoms
patient reported outcome of the Daily Symptoms survey
Time frame: every 12 weeks for a period of 36 months
Medical History
data regarding medical history reported by the patient
Time frame: every 12 weeks for a period of 36 months
Hospitalization
data regarding hospitalization reported by the patient
Time frame: every 12 weeks for a period of 36 months
Demographic information
data regarding demographics reported by the patient
Time frame: every 12 weeks for a period of 36 months
Medication
survey data regarding medication use reported by the patient
Time frame: every 12 weeks for a period of 36 months
MRI utilization
survey data regarding number of MRIs reported by the patient
Time frame: every 12 weeks for a period of 36 months
Exercise
survey data regarding daily exercise
Time frame: collected daily and summarized annually.
System level measure the patient experience for ambulatory care.
Health care quality assessment collected through the Aggregated Clinician and Group Survey to assess patient experience in ambulatory care.
Time frame: every 12 weeks for a period of 36 months
System level measure of Health Care Quality
Patient determined disease steps survey
Time frame: every 12 weeks for a period of 36 months