Multiple Sclerosis

Multiple Sclerosis — MS Quality Improvement

Quality care is incredibly important to both patients and the healthcare teams who care for them.

An Executive Summary¹ from the American Academy of Neurology detailed a way to assess quality care through a series of 11 repeatable and reportable measures. The Mellen Center is working to monitor each of these measures and ensure that improvement is consistent and continual for as many patients as possible.

Fall Risk Screening for Patients With MS

2019 – 2020

Falls are a concern for people who have multiple sclerosis (MS), because they are at increased risk for falls and often do not self-report falls to their healthcare teams. Falls may be associated with injuries, reduced participation in daily activities, and an increased fear of future falls.² A history of falls is a good indicator of future fall risk, so fall screening at visits may determine future fall risk for patients.¹

Percentage of Total Number of Unique MS Patients Seen Who Have a Documented Fall Risk Screening in Epic (Measure 4)

Bladder Infections for Patients With MS

2019 – 2020

Patients who have MS are at risk for urinary tract (bladder) infections (UTIs), 1 of the top 3 reasons for hospitalization of MS patients.³ Patients who have relapses associated with UTIs may not fully recover from the relapse and may retain neurological deficits.⁴ Proper management of MS and bladder function may decrease the rate of UTIs.¹

Percentage of Total Number of Unique MS Patients Seen Who Have a Documented UTI in Epic (Measure 5)

UTI = urinary tract infection

Exercise and Appropriate Physical Activity Counseling

2019 – 2020

Physical activity is important, especially for people with MS. It can improve health, increase participation in social activities, and lead to a higher quality of life.⁵ Despite this, many people with MS remain inactive, which may lead to a progressive decrease in physical capabilities and a cycle of decline. Healthcare partners should assess the physical activity of their patients and discuss the benefits of physical activity, including developing a plan appropriate to the individual needs and abilities of their patients.

Percentage of Total Number of Unique MS Patients Seen Who Have a Documented Physical Activity Assessment in Epic (Measure 6)

Fatigue, Depression, Quality of Life Assessments

Multiple Sclerosis Performance Test Data 2019 – 2020

Fatigue is one of the most commonly reported symptoms of MS and is also considered to be one of the most debilitating.⁶ Monitoring fatigue routinely may allow improved access to behavioral strategies and medications that may provide an opportunity for improvement.¹

Symptoms of depression are common in neurologic diseases like MS and are often seen in conjunction with fatigue and pain.⁷ Assessing depression at clinical visits is essential to ensure that the care team may identify patients who are suffering new or increased symptoms and quickly refer them to the Mellen Behavioral Health Team, who offer a wide variety of services to help Mellen MS patients through difficult times. For many MS patients, the pandemic and the resulting quarantine led to an increased sense of isolation in which they were cut off from family, friends, and their healthcare teams. The true impact of the pandemic on the psyche and quality of life of MS patients is still incompletely understood and is the subject of ongoing research.

Quality of life (QOL) is determined by a mix of physical, social, and psychological elements in a person’s life.⁸ Following the QOL score over time may provide a way to determine how well the patient is managing life with MS overall.¹ If the score decreases, the care team may inquire about specific areas to determine where issues have arisen and appropriate interventions can be suggested where possible (Measure 11).

Assessment20202019

Fatigue outcomeᵃ

Number that completed 2 assessments

Number that maintained or improved fatigue score

1690

762 (45.1%)

1522

662 (43.5%)

Clinical depression outcomeᵇ

Number that completed 2 assessments

Number that maintained or improved depression

873

348 (39.9%)

1387

623 (44.9%)

Quality of life outcomeᶜ

Number that completed 2 assessments

Number that maintained or improved quality of life

873

509 (58.3%)

1387

853 (61.59%)

ᵃFatigue measured by NeuroQoL-Fatigue measure

ᵇDepression measured by NeuroQoL-Depression measure

ᶜQuality of life measured by PROMIS® measure

Mellen Center Key Wellness Measures

2019 – 2020

Optimal health with MS involves more than treatment of relapses, monitoring of disease-modifying therapy, and symptom management. The American Academy of Neurology released an MS quality measure set in 2015.¹ Only 3 of the 11 measures were specific to diagnosis of MS and monitoring of disease activity. The remaining measures are intended to encourage increased attention to symptoms that affect quality of life of MS patients.

Prevention and treatment of comorbid conditions are equally important. Mental comorbidity is common with a lifetime prevalence of 50% for depression and 19% to 41% for anxiety following a diagnosis of MS. Common physical comorbidities include hypertension, hyperlipidemia, arthritis, osteoporosis, and sleep disorders.⁹ These mental and physical comorbid conditions are associated with adverse outcomes. Smoking and vitamin D deficiency may increase disease activity and the risk for developing MS.

Measure2020 (N = 2291)2019 (N = 2384)
BMI assessed1875 (81.84%)2362 (99.08%)
BMI between 18.5 and 24.9 (healthy range)680 (29.68%)688 (28.86%)
Smoking status assessed2023 (88.3%)2363 (99.12%)
Current smoker, any frequency334 (14.58%)330 (13.84%)
Vitamin D level checked2036 (85.4%)2036 (85.4%)
Vitamin D level > 50 mg/mL514 (22.44%)516 (21.64%)

BMI = body mass index

References
  1. Rae-Grant A, Bennett A, Sanders AE, Phipps M, Cheng E, Bever C. Quality improvement in neurology: Multiple sclerosis quality measures: Executive summary. Neurology. 2015 Nov 24;85(21):1904-1908.
  2. Cameron MH, Nilsagard Y. Balance, gait, and falls in multiple sclerosis. Handb Clin Neurol. 2018;159:237-250.
  3. Phé V, Pakzad M, Curtis C, Porter B, Haslam C, Chataway J, Panicker JN. Urinary tract infections in multiple sclerosis. Mult Scler. 2016 Jun;22(7):855-861.
  4. Buljevac D, Flach HZ, Hop WCJ, Hijdra D, Laman JD, Savelkoul HFJ, van Der Meché FGA, van Doorn PA, Hintzen RQ. Prospective study on the relationship between infections and multiple sclerosis exacerbations. Brain. 2002 May;125(Pt 5):952-960.
  5. Backus D. Increasing Physical Activity and Participation in People With Multiple Sclerosis: A Review. Arch Phys Med Rehabil. 2016 Sep;97(9 Suppl):S210-S217.
  6. Rottoli M, La Gioia S, Frigeni B, Barcella V. Pathophysiology, assessment and management of multiple sclerosis fatigue: an update. Expert Rev Neurother. 2017 Apr;17(4):373-379.
  7. Solaro C, Gamberini G, Masuccio FG. Depression in Multiple Sclerosis: Epidemiology, Aetiology, Diagnosis and Treatment. CNS Drugs. 2018 Feb;32(2):117-133.
  8. Yamout B, Issa Z, Herlopian A, El Bejjani M, Khalifa A, Ghadieh AS, Habib RH. Predictors of quality of life among multiple sclerosis patients: a comprehensive analysis. Eur J Neurol. 2013 May;20(5):756-764.
  9. Marrie RA, Hanwell H. General health issues in multiple sclerosis: comorbidities, secondary conditions, and health behaviors. Continuum (Minneap Minn). 2013 Aug;19(4 Multiple Sclerosis):1046-1057.