Joint Commission Disease Specific Care Certification Process for Multiple Sclerosis

Background: The Joint Commission Disease-Specific Care Certification Program (DSC) evaluates clinical performance based on the development and implementation of performance measures specifically relevant for the treatment of a particular disease. This process was introduced to improve the quality of patient care by emphasizing performance based measures.  These measures focus on delivery of quality care and reflect evidence-based medicine or national consensus guidelines for quality care.  The DSC process requires the development of care plans using effective data-driven performance improvement measures.

Objectives:

Identify measurable and meaningful performance standards important for quality care for MS patients

Measure and document consistent execution of performance measures

Demonstrate ability to transition to further performance measures at a large academic medical center over 24 months

Methods: Since there are no nationally recognized consensus guidelines for quality MS care, we identified aspects of MS care that could be measured objectively over time and enhance clinician responsiveness to patient status.  Objective tools, validated for MS patients, were used to develop a plan of care for patients in each performance category.  We chose the following as MS Performance measures: (1) Cognition (Symbol Digits Modalities Test), (2) Depression (Becks Depression Inventory Fast Screen), (3) Ambulatory Status (Timed 25-foot walk), (4) Communication with primary care physician (PCP copied on dictation).  Completion of these tests and implementation of the plan of care were monitored at the MS center with monthly chart audits of performance in 1574 MS annual encounters over two years.  Results from monitoring were discussed at monthly clinic staff meetings and plans to improve performance were identified.   

Results: 

Monthly chart audits indicated high compliance in (1) cognitive screening and plan of care (92% and 91% respectively), (2) depression screening and plan of care (96% and 93%), (3) 25-foot walk and plan of care (97% and 96%), (4) communication with PCP (93% and 68%).

Conclusions:

DSC certification is a clinic-based process for implementing performance measures to improve clinical performance.   At Carolinas Medical Center, we developed performance measures specific to MS care, implemented the use of validated tools in regular clinic visits, and identified areas of improvement.   Through this process, we achieved an improved culture of evidence-based patient care with mechanisms in place to audit and continually verify adherence. The TJC/DSC certification program allows regular addition of new performance measures to achieve these ends.  The Carolinas Multiple Sclerosis Center became the first MS center in the nation to obtain Disease Specific Care certifcation by the Joint Commission.