Advancing consensus priorities for high-impact provider behaviors in multiple sclerosis care: A Delphi study

Area of Science:

• Neurology
• Healthcare Quality Improvement
• Medical Education

Background:

• Access to high-quality Multiple Sclerosis (MS) care is a significant challenge, particularly for those in rural or underserved regions.
• Project ECHO (Extension for Community Health Outcomes) utilizes mentorship and education to connect MS specialists with generalist providers across the United States.
• Identifying specific, measurable provider behaviors is crucial for evaluating the impact of such educational programs on patient care.

Purpose of the Study:

• To identify and define specific provider behaviors that can be assessed after participating in Project ECHO.
• To determine which of these behaviors are most likely to positively influence patient outcomes in MS care.
• To establish a framework for evaluating the effectiveness of Project ECHO's MS program.

Main Methods:

• A two-phase mixed-methods study was employed, beginning with qualitative semi-structured interviews.
• Phase 1 involved 42 participants from four key stakeholder groups to generate a list of high-priority provider behaviors.
• Phase 2 utilized a Delphi exercise with two survey rounds to reach consensus on the most valuable behaviors, mitigating dominance bias.

Main Results:

• Consensus was achieved on 13 provider behaviors with endorsement from at least 73.9% of participants after the second Delphi round.
• These behaviors encompass critical areas such as accurate/timely diagnosis, effective use of disease-modifying therapies (DMTs), and system management.
• Key domains also include patient education, patient-centered communication, multidisciplinary referrals, continuous learning, and leveraging resources like the National MS Society.

Conclusions:

• A consensus-based set of measurable provider behaviors for high-quality MS care has been identified.
• This provides a practical framework for assessing the effectiveness of Project ECHO MS interventions.
• Future research should validate these behaviors as outcome metrics and explore their broader applicability in clinical and educational settings.