7 The multiple sclerosis continuous quality improvement collaborative (MSCQI): interim results of the 3-year multi-center prospective step-wedge randomized research study

Abstract

Background MS-CQI is the first multi-center, randomized research study aiming to improve population health outcomes for people with multiple sclerosis (MS) using quality improvement (QI). Objectives (1) benchmark performance and study variation in utilization and outcomes; (2) provide performance feedback to MS centers; and (3) compare effectiveness of QI versus usual care controls on improving outcomes. Methods Four centers are participating following approximately 5,000 people with MS. We collect 21 Patient Reported Outcome Measures (PROMs) and 11 Electronic Health Record (EHR) measures. System-level de-identified EHR data is collected for all clinical encounters. Individual-level PROM data is collected from participants who consent. Centers are randomized to QI or usual care following a step-wedge randomized design beginning in Year 2. Results MSCQI has recently completed Year 2. At the end of Year 1, EHR n=2,755 encounters, and PROM n=269 individuals (tables 1–3). There is significant variation in EHR findings, including proportion of patients on disease modifying therapy (DMT), MRI, ED, hospitalizations, urgent care, and relapses (table 2), as well as PROM findings (table 3) including depression, fatigue, cognition, sleep, communication, and work-related impairment. In Year 2, the first center (Center C) was randomized to QI. Center C has higher average depression and fatigue severity than the Collaborative, but has realized a reduction in quarterly relapse rate since beginning QI intervention in Quarter 4 (figure 1). Conclusions MSCQI has succeeded in benchmarking system-level variation and has begun studying outcomes of QI intervention versus usual care. MSCQI has potential to improve MS population health outcomes using improvement science methods.