The Hippo


Apr 23, 2019








Brant Oliver

Improving MS care
Study looks at streamlining care, improving outcomes


 By Ryan Lessard
A new nationwide research project out of Dartmouth-Hitchcock aims to identify some ways health care centers can change how they deliver care to patients suffering from multiple sclerosis in order to improve outcomes without increasing costs.
First of its kind
This is the first time researchers have studied MS using collaborative data-sharing between health centers to come up with best practices that have the potential to make life better for patients everywhere, according to principal investigator Brant Oliver. 
“From the public health perspective, MS is one of the most common and disabling neurologic diseases in the United States,” Oliver said.
The disease, which is incurable, affects 2.6 million people worldwide, with progressive symptoms ranging from fatigue and depression to chronic pain.
Oliver, also an assistant professor at Dartmouth College’s Department of Community and Family Medicine, said the idea is to find ways to either incrementally tweak or vastly remake the way existing treatments are administered in a clinical setting with the hope of finding better and more efficient processes. Even a small change, when implemented systemwide, can have far-reaching ripple effects for a patient population.
“Instead of treating an individual patient with a drug and tracking their progress, in this case, they’re treating the whole population that is served by the clinic as the system,” Oliver said.
Oliver has worked on similar process improvement studies for conditions like cystic fibrosis, inflammatory bowel disease and cardiovascular surgeries. In each of those cases, a new intervention or change was compared to existing practices. The IBD project is ongoing, but in the case of cystic fibrosis, researchers found that a simple, low-cost change resulted in improved life expectancy by 10 years. 
“So, really dramatic progress of which improvement efforts were a big part,” Oliver said.
Kids with cystic fibrosis were found to be malnourished because they weren’t metabolizing all the nutrients they would eat. So the intervention was to provide them with nutritional supplements and have the patients visit with a nutritionist four times a year.
The MS study is doing something similar but taking things a bit further. Rather than comparing just one intervention to a control group where nothing changes, researchers are going to compare two interventions at the same time. 
“The field has not done that before,” Oliver said.
The smallest intervention they will be experimenting with is getting centers to increase the share of patients receiving FDA-approved disease-modifying therapies. Oliver said that can mean any evidence-based treatment or medication that helps with MS symptoms. It’s based on a plan developed by the Institute for Healthcare Improvement.
Studies have shown that an increased use of those therapies has reduced relapses on aggregate.
“Relapses are exacerbations of MS that can be quite disabling,” Oliver said.
One of the participating centers, of which there are currently four including Concord Hospital, has only 50 percent of its MS patients on some kind of disease-modifying therapy. So, Oliver said, there is plenty of room for improvement.
The other thing they hope to experiment with is a complete system redesign of the clinical structure. Oliver uses a metaphor to describe how radical a change it is.
“We’re going to knock the house down and make a whole new house and see what happens with that,” he said.
The three-year study has just completed its second quarter in its first year. Out of the four initial participating centers, about 5,600 patients will be involved. By the summer, they will double the scope of the study to eight centers and about 10,000 patients. 
The initial phase of the study has been funded by Biogen, an industry sponsor, to the tune of $1.8 million. 
Researchers will be collecting data on process performance, such as the percentage of patients getting disease-modifying therapies, clinical outcomes such as relapse rates, the number of patients on disability benefits and related symptom severity, as well as costs. That information will come from electronic medical records. 
They will also measure patients’ quality of life, ability to function in relationships and at work, sense of empowerment and patient experience through online surveys. 
Participating centers will be given quarterly updates on the researchers’ findings throughout the study period.
Ultimately, Oliver hopes to pin down and recommend some best practices that can be adopted by centers everywhere.
“The more centers that participate, the more patients we can help,” Oliver said. 

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