系统层面多发性硬化症疾病修正治疗利用的差异：多发性硬化症持续质量改进研究协作组的研究结果。
System-Level Variation in Multiple Sclerosis Disease-Modifying Therapy Utilization: Findings From the Multiple Sclerosis Continuous Quality Improvement Research Collaborative.
机构信息
Jefferson College of Population Health, Philadelphia, PA.
Departments of Community and Family Medicine, Psychiatry, and the Dartmouth Institute for Health Policy and Clinical Practice (TDI), Geisel School of Medicine at Dartmouth, Hanover, NH.
出版信息
Perm J. 2021 Dec 14;25:21.025. doi: 10.7812/TPP/21.025.
BACKGROUND
The Multiple Sclerosis Continuous Quality Improvement (MS-CQI) Collaborative is the first multicenter improvement research collaborative for multiple sclerosis (MS). The main objective of this study is to describe baseline system-level variation in disease-modifying therapy (DMT) utilization across 4 MS centers participating in MS-CQI.
METHODS
Electronic health record data from the first year of the 3-year MS-CQI study were analyzed. Participants were adults ≥ 18 years with MS presenting to any of the 4 MS-CQI centers. DMT utilization was categorized into oral, infusion, and injection types. Multinomial logistic regression was used to investigate associations between centers and DMT utilization.
RESULTS
Overall, 2,029 patients were included in the analysis. Of those patients, 75.1% were female, mean age was 50 years, and 87.4% had relapsing-remitting MS. Overall, 32.7% were on an oral DMT, 23.5% on an infusion DMT, and 43.9% on an injection DMT. Overall, statistically significant differences (p < 0.01) were observed across centers for proportions of patients who received oral, infusion, and no DMTs. There were also overall significant differences (p < 0.01) across MS types for proportions of encounters who received oral, infusion, injection, no DMTs, and mean age varied significantly across centers.
CONCLUSION
System-level effects on MS treatment and outcomes have not been previously studied and our findings contribute initial evidence concerning system-level variation in DMT utilization. Results suggest system-level variation in DMT utilization (ie, after adjusting for individual level factors, MS center or location of care a person with MS engages in care influences DMT treatment choices), resulting in a lack of standardization in DMT management. Continued research and improvement efforts targeting system-level performance could improve outcomes for people with MS.
背景
多发性硬化症持续质量改进（MS-CQI）协作组织是第一个针对多发性硬化症（MS）的多中心改进研究协作组织。本研究的主要目的是描述参与 MS-CQI 的 4 个 MS 中心在疾病修饰治疗（DMT）利用方面的系统水平差异。
方法
分析了为期 3 年的 MS-CQI 研究的第一年的电子健康记录数据。参与者为≥ 18 岁的成年 MS 患者，他们在 4 个 MS-CQI 中心就诊。DMT 的使用分为口服、输注和注射三种类型。使用多项逻辑回归分析来调查中心与 DMT 使用之间的关联。
结果
共有 2029 名患者纳入分析。其中，75.1%为女性，平均年龄为 50 岁，87.4%为复发缓解型 MS。总的来说，32.7%的患者使用口服 DMT，23.5%使用输注 DMT，43.9%使用注射 DMT。总体而言，各中心间接受口服、输注和无 DMT 治疗的患者比例存在统计学差异（p<0.01）。此外，各 MS 类型间接受口服、输注、注射、无 DMT 治疗的患者比例以及平均年龄也存在显著差异（p<0.01）。
结论
以前没有研究过治疗和结果的系统水平影响，我们的研究结果提供了有关 DMT 使用系统水平差异的初步证据。结果表明，DMT 使用存在系统水平差异（即在调整了个体水平因素后，MS 中心或患者就诊的地点会影响 DMT 治疗选择），导致 DMT 管理缺乏标准化。针对系统水平表现的持续研究和改进工作可能会改善 MS 患者的预后。
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