Thomas Jefferson University
College of Population Health

Author Of 3 Presentations

COVID-19 Late Breaking Abstracts

LB1273 - Telehealth Utilization in Four MS Centers During the COVID Pandemic: Real-world evidence from the MS-CQI improvement research collaborative. (ID 2172)

Speakers
Presentation Number
LB1273
Presentation Topic
COVID-19

Abstract

Background

MS-CQI is the first multi-center improvement research collaborative for MS care. MS-CQI is a three-year study (2018-2020) to evaluate system-level performance variation and improve MS population health outcomes. Four MS centers are participating, following approximately 5,000 people with MS. The COVID pandemic onset occurred approximately half-way through the third year of the study. Prior to this time, telehealth was not utilized in participating MS-CQI centers, but after COVID onset, MS-CQI centers began utilizing telehealth in various ways. In response to this development, measures of telehealth utilization were collected in order to study system level variation in telehealth utilization for COVID-era MS care during the last 6 months of the MS-CQI study.

Objectives

To describe system-level variation in MS clinical care utilization by type (in-person visit, telephone visit, or video telehealth visit) for the last six months of the MS-CQI study (January-June 2020) during the COVID pandemic.

Methods

Electronic Health Record (EHR) data from clinical encounters at the four participating MS-CQI centers was abstracted for January-June 2020. Participants were adults ≥18 years with MS. Telehealth utilization was categorized into three types: (1) “in-person” (standard clinical visit); (2) “telephone visit;” and (3) “video telehealth visit.” Chi-square tests were used to assess associations across centers and different types of telehealth utilization.

Results

1,969 unique persons with MS (PwMS) were included in our analysis. 75.4% were female, mean age was 50 years and 79.4% had relapsing MS (RRMS). 1,604 (81.4%) of the 1,969 unique PwMS utilized at least one clinic visit, generating 1,805 total encounters. Of these, 814 (45.1%) utilized in-person, 508 (28.1.%) utilized telephone, and 483 (26.8%) utilized video telehealth visits. Utilization types varied significantly (p<0.01) across MS-CQI centers: (1) in-person (3.8%-52.9%); (2) telephone (0%-31.6%); and (3) video telehealth (9.5-43.4%). Urban MS-CQI centers utilized video telehealth more than rural (39.7% vs. 22.3%), and rural centers utilized telephone visits more often (34.2% vs. 10.8%). Academic MS centers utilized video telehealth visits more than non-academic MS centers (47.0% vs. 18.8%), and non-academic MS centers utilized telephone visits more frequently than academic MS centers (34.7% vs. 11.5%).

Conclusions

Telehealth utilization for MS care has increased dramatically since the onset of the COVID pandemic and is likely to remain a lasting part of MS care in the future. Our findings contribute to initial evidence that system-level (small area geographic) variation in telehealth utilization exists in MS care in the COVID era. This invites further study on how MS care systems can best utilize and standardize telehealth to optimize equity, access, and population health outcomes for PwMS.

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Observational Studies Poster Presentation

P0865 - Disease modifying therapy utilization is influenced by system-level factors: Real-world evidence from the MS-CQI improvement collaborative study. (ID 1814)

Speakers
Presentation Number
P0865
Presentation Topic
Observational Studies

Abstract

Background

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.

Objectives

To describe system-level variation in disease modifying therapy (DMT) utilization for people with MS based on Year 1 (baseline/pre-intervention) results.

Methods

Electronic Health Record (EHR) data from clinical encounters at participating MS centers was used. Participants were adults ≥18 years with MS. DMT utilization was categorized into oral, infusion, and injectable types. Chi-square and adjusted multinomial logistic regression analyses were used to investigate associations between centers and DMT utilization.

Results

2,029 people with MS (PwMS) were included in our analysis: 75.1% female; mean age= 50 years; 87.4% relapsing MS (RRMS). 32.7% were taking an oral, 23.5% infusible, and 43.9% injectable DMT. 23.9% PwMS were not on DMT, and the majority of these were people with RRMS. DMT utilization varied across sites: (1) oral (23-49%); infusion (15.9%-35.8%), and injectable (34.6-55.3%). Adjusting for individual level factors, including MS disease type, disease activity (relapses), demographics, and comorbidities, differences (p<0.01) were observed across centers for proportion received oral, infusible, injectable and no DMT. We also observed differences (p<0.01) across MS types and with increasing age for proportion received oral, infusion, injection, and no DMT treatment.

Conclusions

System-level effects on DMT utilization have not been previously studied and our findings contribute initial evidence that system-level (small area geographic) variation in DMT utilization exists. We also identified that nearly a quarter of PwMS followed by MS-CQI centers were not on DMT treatment and identified a target subpopulation for improvement efforts- people with RRMS not on DMT treatment. Years 2 and 3 of the MS-CQI study involve an evaluation of the effect of system level quality improvement (QI) intervention on population health outcomes for PwMS.

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Observational Studies Poster Presentation

P0911 - Relapses and all-cause hospitalizations are influenced by system-level factors: Real-world evidence from the MS-CQI improvement collaborative study. (ID 1836)

Speakers
Presentation Number
P0911
Presentation Topic
Observational Studies

Abstract

Background

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.

Objectives

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.

Methods

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.

Results

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).

Conclusions

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.

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