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

2021 – 2022

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 dissatisfaction with treatment.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.

Number of total unique MS patients seen at the Mellen Center, treated with DMT, who were screened for DMT side effects. (Measure 2)

DMT = disease modifying therapy

Cognitive Screening for Patients With MS — Processing Speed Test

2021 – 2022

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).⁴

Number of patients with cognitive screening by PST. (Measure 4)

Cognitive Screening for Patients With MS — Neuropsych Referral

2021 – 2022

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

Number of patients with neuropsychological testing who were determined to be cognitively impaired. (Measure 4)

Fatigue Risk Screening for Patients With MS

2021 – 2022

Fatigue is a common problem for people with MS and affects nearly 80% of patients. Fatigue can significantly impact physical activity and daily functioning.³ Appropriate management of fatigue may improve both quality of life in MS patients as well as their ability to maintain employment.¹

Number of total unique patients with 2 or more fatigue assessments who improved their fatigue score. (Measure 5)

Mellen Center Key Wellness Measures

2021 – 2022

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.⁵ 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.

Measure2022 (N = 2536)2021 (N = 2551)
Patients with a primary care physician2255 (88.92%)2278 (89.3%)
Patients who receive health psychology support330 (13.01%)361 (14.15%)
BMI assessed2108(83.12%)2200 (86.24%)
BMI between 18.5 and 24.9 (healthy range)689 (27.17%)722 (28.30%)
Smoking status assessed2259 (89.08%)2327 (91.22%)
Current smoker, any frequency403 (15.89%)406 (15.91%)
Vitamin D level checked1979 (78.04%)2123 (83.22%)
Vitamin D level > 50 mg/mL550 (21.69%)577 (22.61%)
Blood pressure monitored2111 (83.24%)2159 (84.63%)
Patients exhibiting hypertension (bp > 140/80)829 (32.69%)823 (32.26%)

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. 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.
  4. 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.
  5. 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.