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

Access to high-quality MS care remains a critical issue, particularly for patients living in rural or underserved areas. Project ECHO (Extension for Community Health Outcomes) programming includes mentorship and education from MS specialists to generalist providers in the United States. This study sought to identify and define specific provider behaviors that can 1) be evaluated following participation in Project ECHO and 2) are likely to impact patient outcomes.

A two-phase mixed-methods study design was used. In Phase 1, 42 participants representing four key stakeholder groups participated in qualitative, semi-structured interviews. Interviews were coded to generate a list of high-priority provider behaviors, which informed a Delphi exercise in Phase 2 of the study to reach consensus and reduce dominance bias. Phase 2 involved two rounds of Delphi surveys, through which participants endorsed the behaviors they found most valuable.

Following the second round of Delphi surveys, a consensus was reached on 13 provider behaviors that were endorsed by 73.9% or greater of participants. These behaviors span several impactful domains, including accurate and timely diagnosis, effective use of disease-modifying therapies (DMTs), system monitoring and management, patient education, patient-centered communication, multidisciplinary referrals, continued education, and use of resources such as the National MS Society.

This study identified a consensus-driven set of measurable provider behaviors relevant to high-quality MS care, forming a practical framework for evaluating the effectiveness of Project ECHO MS. Future research may focus on validating these behaviors as outcome metrics and exploring their application to broader clinical and educational settings.