Creating a Framework for Reducing Variation in Multiple Sclerosis Services: A Multidisciplinary Approach to Quality Improvement

Background: The recommendations for improving MS services, outlined in a consensus report (Giovannoni G et al. Mult Scler Relat Disord2016;9:S5–48), have been widely endorsed and now need to be implemented. To achieve this, a range of stakeholders must engage in tackling the variations in key domains of MS care highlighted by the report.

Objectives: To develop a quality improvement framework for multiple sclerosis (MS) services that could support healthcare professionals (HCPs) in maximizing lifelong brain health in people with MS.

Methods:  Using action–effect methodology, we proposed a framework of factors affecting MS service delivery. Telephone interviews helped to inform metrics for assessing quality and changes in quality. A UK workshop (Sept 2016) with multidisciplinary HCPs, people with MS, payers and experts in information management refined the framework and outcome measures. To complement this qualitative approach, we conducted surveys of HCPs at ECTRIMS 2016 (9392 delegates) and at the MS Trust 2016 conference (~300 nurses and allied health professionals) to assess priorities for quality improvement. Patient views have also been sought.

Results:  Five major factors were identified which contribute to brain health in people with MS: early referral, early diagnosis, brain-healthy lifestyle, early treatment with disease-modifying therapies (DMTs), and ongoing appropriate treatment with a DMT. Workshop delegates discussed these factors, refined the framework and identified 24 potential outcome measures (e.g. for individuals, ‘date of diagnosis’; for clinics, ‘proportion of eligible patients taking DMT’). At ECTRIMS, 94.4% of 72 surveyed HCPs had tried to improve at least one of the five factors; the most and least common were ‘early treatment with a DMT’ (66.7%) and ‘early referral’ (44.4%), respectively. At the MS Trust conference, 20 of 22 respondents had tried to improve at least one of the five factors – most commonly ‘promoting a brain-healthy lifestyle’ (80%) and ‘appropriate ongoing treatment with a DMT’ (75%).

Conclusions:  Many HCPs are actively trying to improve MS services. The framework of factors described here could provide the basis for an ‘audit’ tool that will allow clinicians and people with MS to benchmark, monitor and improve standards of MS care. Further discussions are planned, to develop and pilot such a tool, with a view to eventual widespread rollout.