QL20
Driving MS Care Quality- Initial Launch Experience from the First Continuous Quality Improvment Learning Health System in Multiple Sclerosis
The Multiple Sclerosis Continuous Quality Improvement (MS-CQI) Collaborative is the first learning health system (LHS) for quality improvement research in multiple sclerosis (MS) in the United States. MS-CQI aims to leverage continuous quality improvement (CQI) methods to: (1) benchmark priority performance indicators and study variation across sites, (2) provide performance feedback; and (3) test the comparative effectiveness of different QI interventions using a randomized research design. Approximately 5,600 people with MS are planned to participate.
Objectives:
Report initial patient reported outcomes (PRO) and electronic medical record (EMR) based outcomes from the MS-CQI study to date.
Methods:
Four MS centers are participating in MS-CQI and additional sites are in process of joining. Measures collected include real-time PRO, administrative data, and quarterly clinical EMR data. To assess comparative performance at the system level, benchmarking analyses across centers will be conducted using hierarchical linear modeling. First year data will be used to establish a baseline for benchmarking analyses. In years 2-3, three centers will be randomized to an improvement intervention following a step wedge randomization process.
Results:
2052 PROs have been reported in the first study quarter, by 131 of 271 active study participants (21% male, 94%white). Nineteen PRO measures are being collected, including (mean, SD): PHQ-9 (7, +/-6) Neuro-Qol Cognitive (31, +/− 7), PDDS (2, +/− 2), and PROMIS Fatigue (MS) (22, +/- 8). First quarter EMR data transmission from participating sites is underway with estimated yield of approximately 800 unique patient encounters. Updated results from the second quarter will be included for presentation.
Conclusions:
Investigation of the comparative effectiveness of system-level QI interventions and their effects on patient experience and functional health is a new area of investigation in MS that is complimentary to other established methodologies (i.e. clinical trials or population health studies focused on clinical outcomes).