System-Level Variation in Multiple Sclerosis Care Outcomes: Initial Findings from the Multiple Sclerosis Continuous...

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.