Clinical and Economic Impact of Teleneurology vs Standard in Clinic Care for Multiple Sclerosis: A Randomized Trial

PROJECT SUMMARY/ ABSTRACT Multiple sclerosis (MS) patients have higher healthcare utilization, reduced work productivity, reduced quality- adjusted life years, and lower health-related quality of life (QOL) relative to the general population. The current standard of outpatient MS care depends on in-clinic visits, but MS patients face many barriers to accessing this care. These barriers include those resulting from the disease itself, such as physical limitations, driving restrictions and financial limitations, and they are further compounded by an overall shortage of neurologists. Furthermore, MS care has a significant economic impact, with the estimated indirect and direct costs for treating MS in the US estimated to be > $48 billion. Therefore, there is a need to improve access to and reduce cost of MS care, and telehealth is a potential solution. Both our two multidisciplinary MS Centers (UCSF and Cleveland Clinic) have demonstrated that telehealth for MS care is feasible and that it results in travel savings for patients, reduction in missed work, and reduction in caregiver burden. Additionally, patient and provider satisfaction is high for this modality of care at the time of care delivery. These initial results are promising, but to date there are no studies assessing the longer-term impact of care delivery via telehealth on the Quadruple Aims of Healthcare: clinical care, cost, patient experience and clinician experience. The proposed study will directly bridge these research gaps in the longer-term impact of care delivery via telehealth. We will complete a two-Center trial, randomizing newly diagnosed MS patients to receive their routine MS care via telehealth or standard in-office care over 2 years. We will enroll 120 patients (assuming ~ 20% dropout rate for 100 completers), and will assess and compare standard clinical outcomes, patient-reported outcomes, costs, patient experience, and clinician care team experience associated with telehealth vs standard in clinic care. We will also conduct exit interviews with purposefully sampled trial participants to better identify facilitators and barriers to telehealth implementation. This study will generate needed evidence regarding the impact of telehealth on clinical outcomes, its cost, and stakeholder experience, and will inform clinical care implementation in other populations of MS patients and other chronic conditions.