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 6 repeatable and reportable measures. The Mellen Center is working to monitor each of these measures to ensure that as many patients as possible benefit from quality improvement.

Disease Modifying Therapy Use and Screening for Side Effects in People With MS

2020 – 2021

Disease modifying therapies (DMTs) are used to prevent disease activity and disability progression in MS patients but can cause side effects that may lead to treatment dissatisfaction.² Consistent screening for side effects allows clinicians to quickly identify and address issues. A dialogue between clinicians and their patients can improve DMT continuation and adherence. In 2021, of the 2551 Mellen Center patients on a DMT, 77.6% (N = 1981) were screened for DMT side effects. (Measure 2)

DMT = disease modifying therapy

Bladder and Bowel Screening for Patients With MS

2020 – 2021

People with MS often report bladder and bowel symptoms that interfere with their quality of life. Responses from a large number of survey participants indicated that 47% reported bladder symptoms and 27.7% reported symptoms affecting the bowels.³ Consistent screening for these symptoms allows clinicians to quickly identify and initiate appropriate treatments. In 2021, 81.54% (N = 2080) of the patients seen at the Mellen Center (N = 2551) were screened for bladder or bowel symptoms. (Measure 3)

Cognitive Screening for Patients With MS — Processing Speed Test

2020 – 2021

Cognitive impairment occurs in 43% to 70% of people with MS and requires specific screening for identification of affected individuals.¹ At the Mellen Center, initial screening is through a simple iPad-based processing speed test (PST).⁷ In 2021, 70.4% (N = 1797) of Mellen Center patients received a cognitive screening by PST. (Measure 4)

Cognitive Screening for Patients With MS — Neuropsych Test

2020 – 2021

Neuropsychological testing is often used to further define cognitive issues in those with a concerning PST score or complaints about their cognitive functioning. Addressing cognitive deficits with appropriate interventions may improve the quality of life of MS patients and prolong their ability to maintain employment.¹ In 2021, 47.1% (N = 73) of the patients with neuropsychological testing were determined to be cognitively impaired. (Measure 4)

Fatigue Risk Screening for Patients With MS — Documented

2020 – 2021

Fatigue is a common problem for people with MS and affects nearly 80% of patients. Fatigue can significantly impact physical activity and daily functioning.⁴ Appropriate management of fatigue may improve both quality of life in MS patients as well as their ability to maintain employment.¹ In 2021, 100% (N = 2551) of the MS patients seen at the Mellen Center have documented fatigue screening in Epic. (Measure 5)

Fatigue Risk Screening for Patients With MS — Assessed

2020 – 2021

In 2021, 42.4% (N = 361) of patients with 2 or more fatigue assessments had an improvement in their fatigue score. (Measure 5)

Exercise and Appropriate Physical Activity Counseling

2020 – 2021

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. In 2021, 83.03% (N = 2118) of the MS patients seen at the Mellen Center have a documented physical activity assessment in Epic. (Measure 6)

Mellen Center Key Wellness Measures

2020 – 2021

Optimal management of MS patients involves more than treating MS. Prevention and treatment of comorbid conditions are also important. Common physical comorbidities include hypertension, hyperlipidemia, arthritis, osteoporosis, and sleep disorders.⁶ Smoking and vitamin D deficiency are risk factors for developing MS and may worsen the disease course. A comprehensive wellness team identified presence of a primary care physician, utilization of health psychology services, body mass index, smoking status, vitamin D level, and blood pressure monitoring as key metrics to quickly assess physical wellness in MS patients.

Measure2021 (N = 2551)2020 (N = 2291)
Patients with a primary care physician2278 (89.3%)2101 (91.7%)
Patients who receive health psychology support361 (14.15%)240 (10.47%)
BMI assessed2200 (86.24%)1875 (81.84%)
BMI between 18.5 and 24.9 (healthy range)722 (28.30%)680 (29.68%)
Smoking status assessed2327 (91.22%)2023 (88.3%)
Current smoker, any frequency406 (15.91%)334 (14.58%)
Vitamin D level checked2123 (83.22%)2036 (85.4%)
Vitamin D level > 50 mg/mL577 (22.61%)514 (22.44%)
Blood pressure monitored2159 (84.636%)1796 (78.39%)
Patients exhibiting hypertension (bp > 140/80)823 (32.26%)732 (31.95%)

BMI = body mass index, bp = blood pressure

  1. Rae-Grant A, Amezcu L, Englis J, et al. Quality Improvement in Neurology: Multiple sclerosis quality measurement set 2020 update. Neurology. 2021;97:135.
  2. Bruce JM, Jarmolowicz DP, Lynch S, et al. How patients with multiple sclerosis weigh treatment risks and benefits. Health Psychol. 2018 Jul;37(7):680-690.
  3. Wang G, Marrie RA, Fox RJ, et al. Treatment satisfaction and bothersome bladder, bowel, sexual symptoms in multiple sclerosis. Mult Scler Relat Disord. 2018 Feb;20:16-21.
  4. Meads DM, Doward LC, McKenna SP, Fisk J, Twiss J, Eckert, B. The development and validation of the Unidimensional Fatigue Impact Scale (U-FIS). Mult Scler. 2009 Oct;15(10):1228-1238.
  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. 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.
  7. Rao, SM, Galioto R, Sokolowski M, et al. Multiple Sclerosis Performance Test: validation of self-administered neuroperformance modules. Eur J Neurol. 2020 May;27(5):878-886.