Quality improvement in neurology: Multiple sclerosis quality measures

Rae-Grant, Alexander; Bennett, Amy; Sanders, Amy; Phipps, Michael; Cheng, Eric M.; Bever, Christopher T.

doi:10.1212/wnl.0000000000001965

Cited by 65 publications

(42 citation statements)

References 27 publications

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“…The time interval between the cognitive assessment of a stable MS patient is under debate [ 81 ]. Both the British National Institute for Health and Care Excellence (NICE) [ 82 ] and AAN [ 4 ] suggest at least an annual routine assessment for these patients, but considering the cost, a fast screening by the treating physician could provide an alternative to patients who cannot afford a full neuropsychological evaluation. More frequent assessment should be reserved for patients with high PML risk or high disease activity, keeping in mind that practice effects may be augmented by frequent testing.…”

Section: When To Measure and How To Deal With Findings?mentioning

confidence: 99%

“…In the setting of a private practice, on the other hand, cognitive assessment may be skipped due to limited time for consultancy. However, the American Academy of Neurology (AAN) underlines the fact that clinicians are often unable to detect cognitive deficits in everyday clinical practice [ 4 ] and emphasizes the importance of cognitive assessment as part of the everyday clinical examination - something that neurologists tend to forget or underestimate.…”

Section: Introductionmentioning

confidence: 99%

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The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians

Bakirtzis

Ioannidis

Messinis

et al. 2018

TONEUJ

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About half of patients with multiple sclerosis exhibit cognitive impairment which negatively affects their quality of life. The assessment of cognitive function in routine clinical practice is still undervalued, although various tools have been proposed for this reason. In this article, we describe the potential benefits of implementing cognitive assessment tools in routine follow -ups of MS patients. Early detection of changes in cognitive performance may provide evidence of disease activity, could unmask depression or medication side-effects and provide suitable candidates for cognitive rehabilitation. Since apathy and cognitive deficiencies are common presenting symptoms in Progressive Multifocal Leukoencephalopathy, we discuss the utility of frequent monitoring of mental status in multiple sclerosis patients at increased risk. In addition, we propose a relevant algorithm aiming to incorporate a systematic evaluation of cognitive function in every day clinical practice in multiple sclerosis.

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Section: When To Measure and How To Deal With Findings?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians

Bakirtzis

Ioannidis

Messinis

et al. 2018

TONEUJ

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“…The last two decades have seen the advent of both disease-modifying therapies (DMTs) and new symptomatic therapies, adding to the complexity of the decision-making process of DMT selection and MS symptom management 3,4. More emphasis is being placed on patient-reported outcomes to help measure clinical outcomes, capture the full impact of the disease, and to determine health care provider (HCP) reimbursement 5,6. Thus, effective communication between patients and their HCPs becomes even more important for understanding the full impact of the disease to achieve optimal clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

Tintoré¹,

Alexander²,

Costello³

et al. 2016

PPA

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BackgroundManaging multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life.MethodsA closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice.ResultsA total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so.ConclusionSeveral important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.

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“…Recent AAN (American Academy of Neurology) guidelines for Quality Measures in MS care recommend an annually collected measure of disability in clinical practice. 10 Although the EDSS is an attractive candidate for this purpose due to its extensive use in clinical trials and ability to capture many aspects of impairment in MS, there are limitations that preclude its use in routine clinical assessment. Barriers to incorporation include the time required to complete the assessment and calculate the scale, which can take more than 30 minutes in patients who are severely disabled.…”

Section: Introductionmentioning

confidence: 99%

Streamlined EDSS for use in multiple sclerosis clinical practice: Development and cross-sectional comparison to EDSS

et al. 2017

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Quality improvement in neurology: Multiple sclerosis quality measures

Cited by 65 publications

References 27 publications

The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians

The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

Streamlined EDSS for use in multiple sclerosis clinical practice: Development and cross-sectional comparison to EDSS

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