Implementation of a Quality Improvement Program in An MS Clinic

Background: Spiraling health care costs have created widespread interest in in solutions which improve the effectiveness and efficiency of the health care system. The Affordable Health Care Act and the Health Information Technology for Economic and Clinical Health Act have created the formidable task of improving quality, enhancing equity, and ensuring value in the United States.  Many MS organizations have played a key role in defining quality measures and providing clinical guidelines for practicing MS care, yet little literature exists to identify and monitor such indicators relative to MS care.

Objectives: Establish a quality improvement initiative within our MS Center

Methods: Our staff  reviewed quality indicators proposed by the research of Cheng et al,  directives developed by the AAN and clinical practice guidelines of the CMSC and the NMSS. We chose the FADE model when developing our processes as it allows for analysis, implementation, and review.  We have previously performed and continue quality improvement with lumbar puncture performance. Outcomes include the use of atraumatic needles, rate of post dural puncture headache, and prompt notification of results. Ongoing QI measures include adherence to laboratory safety testing by patients on immunosuppressive medicines, periodic rechecking of JC virus serology on natalizumab patients who previously tested negative.  Newly developed measures include assuring that patients with repeated urinary tract infections are appropriately screened and managed for urinary retention or other abnormalities, prior mitoxantrone recipients receive follow-up testing for cardiomyopathy, and fingolimod patients receive appropriate follow up serologic and ophthalmologic testing. Multiple additional measures and outcomes are in development. 

Results: Data  is reviewed quarterly  at staff meetings and several items are presented at our institution's Total Quality and Patient Safety Council Meetings twice yearly. Tables representing each indicator as well as our monitoring system are presented along with the practice standards and quality measures previously accepted by the interdisciplinary team. Use of the FADE model is illustrated.  

Conclusions: Staff participation within the quality and safety improvement initiatives for MS care has resulted in the establishment of standard practices within the department which have ultimately impacted patient safety.  Adapting the electronic health record has proved to be an efficient system to monitor these goals.  These initiatives can be managed by many members of the interdisciplinary team to deliver high level quality care to patients. Monitoring care provided to our patients has resulted in effective strategies which have potentially limited adverse events in patients.  Care deficiencies can be identified and new methods can be designed for continuous quality improvement.