System-Level Variation in Multiple Sclerosis Disease-Modifying Therapy Utilization: Findings From the Multiple...

Area of Science:

• Neurology
• Health Services Research
• Quality Improvement Science

Background:

• The Multiple Sclerosis Continuous Quality Improvement (MS-CQI) Collaborative is the first multicenter research initiative focused on improving care for multiple sclerosis (MS).
• Understanding system-level variations in disease-modifying therapy (DMT) utilization is crucial for optimizing MS management.

Purpose of the Study:

• To describe baseline system-level variation in DMT utilization across four MS centers within the MS-CQI Collaborative.
• To identify differences in DMT prescribing patterns based on the healthcare system.

Main Methods:

• Analysis of electronic health record data from the first year of the MS-CQI study.
• Inclusion of adult patients (≥18 years) diagnosed with MS across four participating centers.
• Categorization of DMTs into oral, infusion, and injection types, with multinomial logistic regression used to assess center-specific associations.

Main Results:

• A total of 2,029 patients were analyzed; 75.1% were female, with a mean age of 50 years, and 87.4% had relapsing-remitting MS.
• Significant variations (p < 0.01) were observed across centers in the proportions of patients receiving oral (32.7%), infusion (23.5%), and injection (43.9%) DMTs, as well as those receiving no DMT.
• Significant differences in DMT utilization and mean age were also noted across different MS types.

Conclusions:

• This study provides initial evidence of system-level variation in DMT utilization for MS, indicating that the healthcare setting influences treatment decisions.
• The observed lack of standardization in DMT management underscores the need for targeted quality improvement efforts.
• Further research and interventions focused on system-level performance are essential to enhance outcomes for individuals with MS.