A Patient-Centered Medical Home Model for Measuring Multiple Sclerosis Outcomes

At the 2013 Annual Meeting of the Consortium of Multiple Sclerosis Centers, Diana Logan, RN, of the Clinical Center for Multiple Sclerosis at the University of Texas Southwestern (UTSW) in Dallas described her multidisciplinary experiences working in a patient-centered medical home model for multiple sclerosis (MS) in a talk titled, “Outcome Measures in the MS Setting-Can It Be Done?”

Logan started her talk with one profoundly simple statement. She said that we could completely revolutionize healthcare and save millions of dollars if we could just do three things: (1) bathe our patients, (2) offer them water to drink, and (3) take them for walks outdoors. However, she said that it is often easier or more convenient to prescribe a medication or other expensive intervention than to do some of these activities.

Logan argued that MS is too complex for a primary care physician to direct care, and that certainly the patient is not the best person to determine what kind of healthcare practitioner they should see next. She said that it is important for hospitals to have in place a coordinated plan for who should be in charge of organizing the management of a MS patient (she said that neurologists are best equipped to direct the care of MS patients).

Moreover, Logan stressed that effective treatment requires intervention by a multidisciplinary team, since there are so many different interdependent symptoms affecting MS pathogenesis. This team should include a neurologist, a nurse practitioner, a social worker, a physical therapist, a dietician, a pain management specialist, a pharmacist, and other therapists that may be needed such as speech or occupational therapists. Unfortunately, reimbursements are generally lacking for social workers and dieticians in most MS treatment center settings.

The medical home model was created in 1967 by The American Academy of Physicians for children with special needs but this model has recently evolved to cover all ages of patients. This includes a medical home model specifically for MS at UTSW that is known as The Total Life Care (TLC) Clinic.

Every Monday at the TLC clinic, Logan’s group meets with high-risk MS patients to discuss therapy goals and challenges, reinforce previous lessons, and perform global assessments to evaluate the patients. It is a long process for the patient that takes approximately 3-4 hours. Patients are encouraged to return in 3-4 months for evaluation. Once their therapeutic and rehabilitative goals are achieved they “graduate” from the program.

To measure outcomes for patients at TLC, researchers used the WHOQOL-BREF, an instrument that comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environment. Out of 243 patients that began the TLC program, just 7% graduated after an average of 3.5 visits. Quality of life was improved for physical health, psychological health, social relationships, and the environment based on WHOQOL-BREF measures.

Patients with MS often focus only on the therapies that are easiest or most enjoyable for them, and neglect other needed interventions. Because of this, and because MS is a complex disease that Logan likened to “a constantly moving target,” it is important to have an organized, dedicated staff that can help patients to address all issues related to their therapy. Still, Logan said that it is also important to find out from the patient what is most important to them and that therapy goals must be patient-driven, not hospital staff-driven.