Abstract Details

Title Characteristics of People with MS Referred for Comprehensive Care and Association with MS Outcomes

Topic Multiple Sclerosis

Presentation(s) P4 - Poster Session 4 (5:00 PM-6:00 PM)

Poster/Presentation
Number 1-012

Objective To identify characteristics of people with multiple sclerosis (PwMS) that are associated with order placement in comprehensive care domains.

Background

Clinical guidelines recommend comprehensive care for PwMS; however, actual referral patterns are unknown.

Design/Methods Retrospective cohort study of adult PwMS who completed ≥2 office visits at least 18 months apart from 1/2019-6/2023 at a single MS Center. Orders placed in 8 domains (rehabilitation, mental health, spasticity, bladder, bowel, cognition, social work, fatigue) were evaluated. Pearson’s Chi-squared test was used to assess the relationship between demographic characteristics and comprehensive care referrals. Neurological worsening was defined by a 4-point decrease in processing speed test or 20% worsening in the 9-hole peg test [9HPT) or timed 25-foot walk [T25FW] at the last visit. Negative binomial regression models were used to assess the impact of neurological worsening on the the total number of comprehensive care domains addressed during the study period adjusting for covariates including race, ethnicity, gender, location, ADI, insurance, MS type, and comorbidities at baseline.

Results 3,735 PwMS were included (72% female, 12% Black, 62% relapsing remitting). A higher proportion of Black PwMS compared to White PwMS received orders for most domains (rehabilitation 60% vs 41%; mental health 14% vs 9.3%; cognition 17% vs 12%; social work 27% vs 11%, p<0.05 for all). Similarly, significantly more comprehensive care orders were placed for PwMS that were Hispanic, those with more comorbidities, greater disability, progressive disease course, and Medicare/Medicaid insurance. Compared to PwMS without worsening, those with worsening in the 9HPT (IRR 1.26, 95%CI 1.13–1.40, p<0.01) and the T25FW (IRR 1.29, 95%CI 1.17-1.42, p<0.01) had higher rates of receiving care orders, adjusted for covariates.

Conclusions Greater number of comprehensive care orders for Black and Hispanic patients may suggest attributes of a more severe disease process in these patients or confounding factors (e.g. delayed presentation) requiring further investigation.

Authors/Disclosures
Elizabeth A. Page, MD (Cleveland Clinic) PRESENTER	Dr. Page has nothing to disclose.
Mengke Du (Cleveland Clinic)	Mengke Du has nothing to disclose.
Julia O'Mahony (The Hospital for Sick Children)	Ms. O'Mahony has nothing to disclose.
Daniel Ontaneda, MD, PhD, FAAN (Cleveland Clinic)	Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech/Roche. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. The institution of Dr. Ontaneda has received research support from NIH. The institution of Dr. Ontaneda has received research support from PCORI. The institution of Dr. Ontaneda has received research support from NMSS. The institution of Dr. Ontaneda has received research support from Genetech.
Marisa P. McGinley, DO (Cleveland Clinic)	Dr. McGinley has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. McGinley has received research support from Biogen. The institution of Dr. McGinley has received research support from Genentech. The institution of Dr. McGinley has received research support from NIH. The institution of Dr. McGinley has received research support from AHRQ. The institution of Dr. McGinley has received research support from EMD Serono.

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