Introduction

Treatment of MS-related symptoms is a complex, individualized process and the development of universally-agreed upon quality measures or guidelines has proved extremely difficult. Symptomatic management involves widely different treatment strategies for individual patients, some pharmacologic and some non-pharmacologic. While many pharmacologic therapies used to alleviate symptoms of MS are approved to treat those symptoms, few agents for symptomatic relief, however, have been studied specifically in patients with MS. Many of these therapies come with their own associated sets of benefits and risks. Therefore clinical assessment and defining the success of these treatments often relies on data points derived outside MS, qualitative input and/or adverse events. Compounding this issue is that symptoms of MS cross so many disciplines of medicine, that many clinicians do not have the appropriate foundation or evidence to assess and implement improvement strategies in many of these areas. Thus, management of MS-associated symptoms represents one of the most challenging clinical aspects of the disease.

To address this challenge, a performance improvement CME activity was developed to help clinicians in multiple sclerosis centers improve the management of MS-related symptoms. This toolkit was developed based on the PI CME activity and provides clinicians with additional MS tools, resources and strategies to implement their own performance improvement activity.

This PI CME activity was co-sponsored by The Academy for Continued Healthcare Learning, PeerView Institute, Purdue University College of Pharmacy, and supported by an educational grant from Acorda Therapeutics.

Instructions for Implementation

This toolkit was created based on a completed performance improvement CME activity, and accordingly is designed based on the following model of performance or quality improvement:

1. Stage A: Learning from current practice performance assessment
2. Stage B: Learning from the application of PI to patient care
3. Stage C: Learning from the evaluation of the PI effort

Instructions for Stage A:

1. Review a minimum of 20 patient charts (or another number determined to be appropriate) from patients most recently admitted, and complete the Data Collection Form, one form per patient chart
2. Calculate and analyze how patients’ disease-related symptoms were managed based on the provided Performance Measures and Calculation Instructions
3. Set goals for performance improvement

Instructions for Stage B:

1. Educate MS facility clinicians on best practices; PowerPoint slides used for clinical in-service meetings are available online and/or you can use other sources to customize the education as needed
2. Develop and implement action plans for improvement (at the facility level and/or clinician level, as determined to be relevant and appropriate)

Instructions for Stage C:

1. Allow several weeks for the action plan(s) to take effect—the amount of time needed will depend on several factors, including the specific actions taken and number of MS patients at facility
2. Identify 20 new patients (or another number determined to be appropriate) admitted to MS facility since completion of Stage B, and complete the same Data Collection Form, one form per patient chart
3. Calculate and analyze how patients’ disease-related symptoms were managed based on the provided Performance Measures and Calculation Instructions, and compare to clinician performance in Stage A
4. If desired, set new performance goals again and repeat Stages B and C to reach desired outcome.

Resources for Stage B Interventions/Action Plans

Below is a list of resources and activities available to MS centers and clinicians, for implementation as part of Stage B. Please select the education to include in action plans based on what is most relevant to your needs, and the actions that you feel will be most helpful in achieving the goals identified. This is not a comprehensive list of resources or interventions available for Stage B; you may determine other education or action plan components that are more relevant based on your specific performance goals.