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Updated: Nov 2, 2025

The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
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System-Level Variation in Multiple Sclerosis Care Outcomes: Initial Findings from the Multiple Sclerosis Continuous

Brant J Oliver1,2,3,4, Karen Walsh5, Randall Messier6

  • 1Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock-Health, Lebanon, New Hampshire, USA.

Population Health Management
|June 17, 2021
PubMed
Summary

Where people with multiple sclerosis (MS) receive care impacts their health outcomes. This study reveals system-level variations in treatment and relapse rates, highlighting the need for care system improvements.

Keywords:
complex/chronic/costlycoproductionimplementationpatient-reported outcomespopulation healthquality improvement

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Area of Science:

  • Neurology
  • Health Services Research
  • Public Health

Background:

  • Multiple sclerosis (MS) is a complex, chronic, and costly neurological condition affecting 1 million US adults.
  • Previous research has not assessed system-level effects of small-area variation on MS population health outcomes.
  • System-level effects are documented in other complex chronic conditions like cystic fibrosis and rheumatoid arthritis.

Purpose of the Study:

  • To investigate system-level (small-area variation) effects on MS population health outcomes.
  • To analyze the impact of care location on MS relapses, disease-modifying therapy (DMT) utilization, and brain MRI utilization.
  • To establish the presence of system-level variation effects in a multicenter MS population study.

Main Methods:

  • Stepwise binary logistic regression analyses were performed.
  • Data were collected during the baseline period of the Multiple Sclerosis Continuous Quality Improvement (MS-CQI) study.
  • Analyses controlled for demographic factors (age, sex) and other potential confounders.

Main Results:

  • Significant differences in demographic and disease characteristics were observed between MS centers.
  • Controlling for confounders, significant system-level effects were found on DMT utilization, MRI utilization, and relapses.
  • Outcomes showed significant relationships with urgent care utilization, including emergency department visits and hospitalizations.

Conclusions:

  • Care location significantly influences health outcomes for people with MS (PwMS).
  • Evidence establishes the presence of system-level variation effects on MS outcomes in a multicenter study.
  • Results support continued system-level research and quality improvement initiatives to optimize MS population health.