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Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis

BACKGROUND: Multiple sclerosis (MS) quality of care guidelines are consensus-based. The effectiveness of the recommendations is unknown. OBJECTIVE: To determine whether clinic-level quality of care affects clinical and patient-reported outcomes. METHODS: This nationwide observational cohort study in...

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Autores principales: He, Anna H, Manouchehrinia, Ali, Glaser, Anna, Ciccarelli, Olga, Butzkueven, Helmut, Hillert, Jan, McKay, Kyla Anne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413789/
https://www.ncbi.nlm.nih.gov/pubmed/37392018
http://dx.doi.org/10.1177/13524585231181578
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author He, Anna H
Manouchehrinia, Ali
Glaser, Anna
Ciccarelli, Olga
Butzkueven, Helmut
Hillert, Jan
McKay, Kyla Anne
author_facet He, Anna H
Manouchehrinia, Ali
Glaser, Anna
Ciccarelli, Olga
Butzkueven, Helmut
Hillert, Jan
McKay, Kyla Anne
author_sort He, Anna H
collection PubMed
description BACKGROUND: Multiple sclerosis (MS) quality of care guidelines are consensus-based. The effectiveness of the recommendations is unknown. OBJECTIVE: To determine whether clinic-level quality of care affects clinical and patient-reported outcomes. METHODS: This nationwide observational cohort study included patients with adult-onset MS in the Swedish MS registry with disease onset 2005–2015. Clinic-level quality of care was measured by four indicators: visit density, magnetic resonance imaging (MRI) density, mean time to commencement of disease-modifying therapy, and data completeness. Outcomes were Expanded Disability Status Scale (EDSS) and patient-reported symptoms measured by the Multiple Sclerosis Impact Scale (MSIS-29). Analyses were adjusted for individual patient characteristics and disease-modifying therapy exposure. RESULTS: In relapsing MS, all quality indicators benefitted EDSS and physical symptoms. Faster treatment, frequent visits, and higher data completeness benefitted psychological symptoms. After controlling for all indicators and individual treatment exposures, faster treatment remained independently associated with lower EDSS (−0.06, 95% confidence interval (CI): −0.01, −0.10) and more frequent visits were associated with milder physical symptoms (MSIS-29 physical score: −16.2%, 95% CI: −1.8%, −29.5%). Clinic-level quality of care did not affect any outcomes in progressive-onset disease. CONCLUSION: Certain quality of care indicators correlated to disability and patient-reported outcomes in relapse-onset but not progressive-onset disease. Future guidelines should consider recommendations specific to disease course.
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spelling pubmed-104137892023-08-11 Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis He, Anna H Manouchehrinia, Ali Glaser, Anna Ciccarelli, Olga Butzkueven, Helmut Hillert, Jan McKay, Kyla Anne Mult Scler Original Research Papers BACKGROUND: Multiple sclerosis (MS) quality of care guidelines are consensus-based. The effectiveness of the recommendations is unknown. OBJECTIVE: To determine whether clinic-level quality of care affects clinical and patient-reported outcomes. METHODS: This nationwide observational cohort study included patients with adult-onset MS in the Swedish MS registry with disease onset 2005–2015. Clinic-level quality of care was measured by four indicators: visit density, magnetic resonance imaging (MRI) density, mean time to commencement of disease-modifying therapy, and data completeness. Outcomes were Expanded Disability Status Scale (EDSS) and patient-reported symptoms measured by the Multiple Sclerosis Impact Scale (MSIS-29). Analyses were adjusted for individual patient characteristics and disease-modifying therapy exposure. RESULTS: In relapsing MS, all quality indicators benefitted EDSS and physical symptoms. Faster treatment, frequent visits, and higher data completeness benefitted psychological symptoms. After controlling for all indicators and individual treatment exposures, faster treatment remained independently associated with lower EDSS (−0.06, 95% confidence interval (CI): −0.01, −0.10) and more frequent visits were associated with milder physical symptoms (MSIS-29 physical score: −16.2%, 95% CI: −1.8%, −29.5%). Clinic-level quality of care did not affect any outcomes in progressive-onset disease. CONCLUSION: Certain quality of care indicators correlated to disability and patient-reported outcomes in relapse-onset but not progressive-onset disease. Future guidelines should consider recommendations specific to disease course. SAGE Publications 2023-06-30 2023-08 /pmc/articles/PMC10413789/ /pubmed/37392018 http://dx.doi.org/10.1177/13524585231181578 Text en © The Author(s), 2023 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Papers
He, Anna H
Manouchehrinia, Ali
Glaser, Anna
Ciccarelli, Olga
Butzkueven, Helmut
Hillert, Jan
McKay, Kyla Anne
Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis
title Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis
title_full Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis
title_fullStr Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis
title_full_unstemmed Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis
title_short Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis
title_sort association between clinic-level quality of care and patient-level outcomes in multiple sclerosis
topic Original Research Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413789/
https://www.ncbi.nlm.nih.gov/pubmed/37392018
http://dx.doi.org/10.1177/13524585231181578
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