MS-CQI is the first multi-center improvement research collaborative to improve system-level performance and population health outcomes for people with MS. MS-CQI is a three year study (2018-2020) to evaluate system-level performance variation and improve population health outcomes in MS care. Four MS Centers are participating, following approximately 5,000 people with MS.
To describe system-level variation in two important population health outcomes for people with MS based on Year 1 (baseline/pre-intervention) results from the MS-CQI study: (1) relapses (exacerbations); and (2) all-cause hospitalizations.
MS-CQI collects eleven clinical electronic health record (EHR) outcome measures from outpatient clinical encounters in participating MS centers longitudinally-- including MS relapses, and all-cause hospitalizations. We also collect demographic information and comorbidities. We used ANOVA, multiple regression, and maximum likelihood estimation methods for inferential analyses to assess for system level variation in outcomes.
Four MS centers in the U.S. are participating: an urban academic center (n=1,000); a rural academic center (n=1,000); a rural community hospital (n=1,500); and an urban private practice (1,500), following a total N=5,000 persons with MS (PwMS). Univariate analyses found significant differences between sites for relapses, disease modifying therapy (DMT), MRI utilization, emergency department utilization, comorbidities, and all-cause hospitalizations. Center-specific proportions of PwMS with at least 1 relapse ranged 5-16.9%. Mean relapse rate varied significantly (p<0.01) across all centers. Two sites were below the MS-CQI average of 7% (3.3%, 6.3%) and two were above the average (8.5%, 10.3%). Controlling for individual factors and covariates, and using the highest volume center as the referent group, logistic regression analyses identified significant center level effects on relapses in Year 1, with comparator sites demonstrating ORs as high as 2.61 (95% CI: 1.8, 3.8). Similarly, significant site (system) level effects (with high performing center specified as the referent group) were found for all-cause hospitalizations- with comparator sites demonstrating odds ratios (ORs) ranging as high as 2.4 (95% CI: 1.34, 4.4).
Adjusted analyses of population level data from the MS-CQI study identified significant geographic system-level variation in MS relapses and all-cause hospitalizations, suggesting that system-level (small area geographic variation) factors are influencing population level outcomes for these outcomes. Findings suggest that continued study of system-level variation and improvement may be needed to optimize these outcomes for people with MS.