Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Mult Scler. 2023 Aug;29(9):1126-1135. doi: 10.1177/13524585231181578. Epub 2023 Jun 30.
Multiple sclerosis (MS) quality of care guidelines are consensus-based. The effectiveness of the recommendations is unknown.
To determine whether clinic-level quality of care affects clinical and patient-reported outcomes.
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.
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.
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.
多发性硬化症（MS）质量护理指南是基于共识的。这些建议的有效性尚不清楚。
确定临床层面的护理质量是否会影响临床和患者报告的结果。
这项全国性观察性队列研究纳入了瑞典多发性硬化症注册中心中发病于 2005-2015 年的成年发病 MS 患者。通过四个指标衡量临床层面的护理质量：就诊密度、磁共振成像（MRI）密度、开始使用疾病修正治疗的平均时间和数据完整性。结局为扩展残疾状况量表（EDSS）和多发性硬化症影响量表（MSIS-29）测量的患者报告症状。分析调整了个体患者特征和疾病修正治疗的暴露情况。
在复发型 MS 中，所有质量指标都改善了 EDSS 和身体症状。更快的治疗、更频繁的就诊和更高的数据完整性均改善了心理症状。在控制所有指标和个体治疗暴露后，更快的治疗仍与较低的 EDSS 独立相关（-0.06，95%置信区间（CI）：-0.01，-0.10），更频繁的就诊与更轻微的身体症状相关（MSIS-29 身体评分：-16.2%，95% CI：-1.8%，-29.5%）。在进行性疾病中，临床层面的护理质量与任何结局均无关。
某些护理质量指标与复发型疾病的残疾和患者报告结局相关，但与进行性疾病无关。未来的指南应考虑针对疾病病程的具体建议。
