Constructing an adaptive care model for the management of disease-related symptoms throughout the course of multiple sclerosis—performance improvement CME

Abstract

Background: Symptom management remains a challenging clinical aspect of MS. Objective: To design a performance improvement continuing medical education (PI CME) activity for better clinical management of multiple sclerosis (MS)-related depression, fatigue, mobility impairment/falls, and spasticity. Methods: Ten volunteer MS centers participated in a three-stage PI CME model: A) baseline assessment; B) practice improvement CME intervention; C) reassessment. Expert faculty developed performance measures and activity intervention tools. Designated MS center champions reviewed patient charts and entered data into an online database. Stage C data were collected eight weeks after implementation of the intervention and compared with Stage A baseline data to measure change in performance. Results: Aggregate data from the 10 participating MS centers (405 patient charts) revealed performance improvements in the assessment of all four MS-related symptoms. Statistically significant improvements were found in the documented assessment of mobility impairment/falls (p=0.003) and spasticity (p<0.001). For documentation of care plans, statistically significant improvements were reported for fatigue (p=0.007) and mobility impairment/falls (p=0.040); non-significant changes were noted for depression and spasticity. Conclusions: Our PI CME interventions demonstrated performance improvement in the management of MS-related symptoms. This PI CME model (available at www.achlpicme.org/ms/toolkit) offers a new perspective on enhancing symptom management in patients with MS.

Spread tools: a systematic review of components, uptake, and effectiveness of quality improvement toolkits

“…Competence in supporting shared treatment decisions was higher than confidence ( p < .001) and involvement ( p = .01). Confidence in accessing reliable health information over the internet was lower than ratings of involvement ( p = .02). Procedures : NR Patients : NRMiller 2014 [43]USMultiple sclerosis symptom managementMultiple Sclerosis clinic# hospitals: 10# providers: 37# patients: 405Pre-postToolkit: Constructing an Adaptive Care Model for the Management of Disease-Related Symptoms Throughout the Course of Multiple Sclerosis Implementation : Implementation instructions and tips; sample data collection form; slide deck Provider : Clinical management algorithm, clinical practice guidelines, best practices for symptom management, online continuing medical education activities Patient : NR Other intervention : Training for intervention heads, planning meetings, live workshop Uptake : NR Utility : Providers reported time and personnel constraints as a barrier to implementation, providers reported the intervention allowed for comprehensive management of the disease, and improved patient care overall Providers : Providers reported increased awareness of MS symptoms Procedures : 6% ( p = .003) improvement in documented symptom assessment for mobility impairment/falls and 10% ( p < .001) for spasticity assessment documentation; documented care plan performance measures improved for fatigue (13%, p = .007) and mobility impairment/falls (13%, .040). Use of the timed 25-foot walk test increased from 25 to 46% ( p < .001), use of clinic questionnaire for spasticity improved from 3 to 9% ( p < .001).…”

“…One study reported that 50% of respondents found the toolkit information “some or very much helpful” [32], another reported 75% of respondents found the toolkit “extremely or very helpful” [15], one study reported ratings of “being helpful to staff” that ranged between 73 and 92% [33], one study documented that clinicians were “extremely satisfied or satisfied” in 11/11 discussions [70], in one study 86% of respondents agreed that the toolkit was helpful in clinical decision-making [62], and another study reported that 85% of staff who had read the toolkit found it helpful [29]. One study reported that most staff at three out of four sites believed the toolkit improved efficiency for adult vaccinations [51], one study found that all participants were “very satisfied or satisfied” with the overall usefulness of the toolkit [17], and one highlighted that the toolkit enabled comprehensive disease management and improved overall patient care [43]. In another study, most staff and stakeholders had described the toolkit as a useful resource [69], and three studies indicated that feedback was “positive” [22, 23, 63].…”

“…Seventeen studies reported on barriers to staff implementing the toolkit [13, 24, 27, 43, 49, 59, 62, 74–76, 78, 79, 81, 84–86, 88]. Common cited barriers included time constraints [21, 24, 43, 59, 62, 65, 85, 86, 88], no pertinent personnel available [13, 27, 43, 74, 88], culture or institutional factors [27, 74, 75], limited resources or costs [13, 24, 27, 49, 74, 85, 86], competing demands [65, 75, 86], or dissatisfaction with the toolkits content [24, 62]. Some study explored facilitators and barriers such as support from leadership [59] or whether a component could be implemented quickly and/or easily, especially when the tool or template was immediately available [24].…”

“…More than half of the included studies (57%) reported specific effects on clinical practice such as procedural changes [12–14, 16, 19–21, 24–26, 34–40, 42, 43, 45–47, 51, 52, 55, 56, 58, 59, 61–71, 74, 76, 78, 81–83, 85, 87]. In most cases, studies reported on the adherence to procedures suggested in the toolkit such as appointing a pediatric physician coordinator [13], counseling children and their families on weight and healthy lifestyles [86], and documenting symptom assessment for mobility impairment or falls [43]. The evidence table shows the range of findings reported in individual studies.…”

“…The Bright Futures Training Intervention Project toolkit was associated with statistically significant increases in the use of a preventive service prompting system and the proportion of families asked about special health care needs, but not the proportion of children who received a structured developmental assessment [24]. A toolkit to support multiple sclerosis management was associated with some improvements in documented assessments and care plan documentation [43]. A pre-post study evaluating the 4 Pillars Toolkit found different results for the different vaccines and different sites [51].…”