Improving Quality and Value of Multiple Sclerosis Care at the Microsystem Level: The Multiple Sclerosis Continuous Quality Improvement (MSCQI) Collaborative
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 694
- Locations
- 4
- Primary Endpoint
- Disease modifying therapy utilization
Study Overview
Brief Summary
To establish the first systems level continuous quality improvement (CQI) collaborative for multiple sclerosis (MS) in the United States, to conduct benchmarking analyses and assessments of geographic variation in MS care quality and value, and study the effect of CQI interventions on improvement of selected performance (quality) indicators.
Detailed Description
This is a three year study which employed a step-wedge randomized design which exposed three of four participating centers to a healthcare QI intervention during the 3 year period. Each of the centers exposed to an intervention served as its own control during a baseline pre-intervention period during the first year of the study. The fourth site served as a longitudinal control for comparison to the other three centers exposed to a QI intervention.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Adults aged 18 years or older with documented clinically confirmed MS who are followed by one of the participating MS centers.
Exclusion Criteria
- •Candidates will be excluded from study entry if they are unable or unwilling to provide informed consent.
Arms & Interventions
Baseline Analysis
To conduct studies of variation in performance across microsystems and to utilize benchmarking analyses to identify top performers.
The effect of continuous quality improvements (CQI)
To study the comparative improvement of selected primary process performance indicators (DMT and MRI process measures) over a 3 year period (Years 2-3) in microsystems receiving CQI interventions versus those not receiving CQI intervention, and between two different CQI intervention types (IHI Breakthrough Series and Patient Centered Medical Home).
Intervention: Quality Improvement (Other)
Outcomes
Primary Outcomes
Disease modifying therapy utilization
Time Frame: every 12 weeks for a period of 36 months
The percentage of eligible MS patients on disease modifying therapy (DMT access), which is operationally defined as the total number of eligible patients on DMT/the total number of patients seen per quarter at a participating center for whom DMT is an appropriate treatment option.
Secondary Outcomes
- Clinic Outcome for Anxiety(every 12 weeks for a period of 36 months)
- Clinic Outcomes for Vitamin D levels in MS patients(every 12 weeks for a period of 36 months)
- Clinic Outcomes for fatigue(every 12 weeks for a period of 36 months)
- Clinic Outcomes for the effects of MS on the patient(every 12 weeks for a period of 36 months)
- Clinic Outcomes for the presence of a MS relapse(every 12 weeks for a period of 36 months)
- Clinic Outcomes for satisfaction of treatment by medication(every 12 weeks for a period of 36 months)
- Clinical outcome for Depression(every 12 weeks for a period of 36 months)
- Clinic Outcomes on Cognitive Function(every 12 weeks for a period of 36 months)
- Clinic Outcomes on fine motor skills and activities of daily living(every 12 weeks for a period of 36 months)
- Clinic Outcomes on stigma associated with MS(every 12 weeks for a period of 36 months)
- Clinic Outcomes on ability to participate in social roles and activities(every 12 weeks for a period of 36 months)
- Clinic Outcomes reporting of MS patient daily symptoms(every 12 weeks for a period of 36 months)
- Medical History(every 12 weeks for a period of 36 months)
- MRI utilization(every 12 weeks for a period of 36 months)
- Clinic Outcomes for communication(every 12 weeks for a period of 36 months)
- Hospitalization(every 12 weeks for a period of 36 months)
- Clinic Outcomes on mobility(every 12 weeks for a period of 36 months)
- Clinic Outcomes on satisfaction with social roles and activities(every 12 weeks for a period of 36 months)
- Clinic Outcomes for sleep disturbance(every 12 weeks for a period of 36 months)
- Clinic Outcomes for assesment of patient health status(every 12 weeks for a period of 36 months)
- Demographic information(every 12 weeks for a period of 36 months)
- Exercise(collected daily and summarized annually.)
- System level measure of Health Care Quality(every 12 weeks for a period of 36 months)
- Medication(every 12 weeks for a period of 36 months)
- System level measure the patient experience for ambulatory care.(every 12 weeks for a period of 36 months)
Investigators
Brant J. Oliver
Assistant Professor
Dartmouth-Hitchcock Medical Center