OBJECTIVES : This study describes characteristics and disease modifying therapy (DMT) use among patients in year 1 of Multiple Sclerosis Continuous Quality Improvement (MS-CQI) - the first multicenter improvement research collaborative for Multiple Sclerosis (MS).

METHODS : Baseline electronic health record data was collected via Redcap between 7/1/2017 and 6/30/2018 from four participating MS centers: an urban academic center, a rural academic center, a rural community hospital, and an urban private practice. DMT use was categorized into oral agents, infusibles, injectables, and no DMT use. Chi-square tests were used to analyze differences in proportions of patients using various types of DMTs across centers and MS types.

RESULTS : Of 2,679 MS clinical encounters in the study, 76.1% were female, median age was 52 years, and 83.6% of encounters had RRMS. 30.8% were on an oral agent, 18.0% were on an infusible, 34.4% were on an injectable, 2.3% were on an oral and infusible, 5.0% were on an oral and injectable, 0.19% were on an infusible and injectable, and 23.9% were not on any DMT. No encounters were on all three DMT types. Proportion of encounters on no DMTs ranged from 15.2% to 37.0% across sites, while proportion of encounters on oral agents, infusibles, and injectables ranged from 20.5%-39.1%, 12.5%-31.1%, and 30.2-38.0% across sites, respectively. Statistically significant differences (p<0.0001) were observed across centers for proportions of encounters on oral DMTs, infusible DMTs, and no DMTs. There were significant differences (p<0.0001) across MS types for proportions of encounters who received oral DMTs, infusible DMTs, injectable DMTs, and no DMTs.

CONCLUSIONS : MS-CQI baseline DMT use from EHR have shown significant variation in type of DMT use at the systems level. Outcomes of MS care may be influenced by site-level variation and further research is needed to evaluate the effects of different DMT types on system-level population health outcomes.