Thomas Jefferson University
College of Population Health

Author Of 1 Presentation

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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