Multiple Sclerosis at Home Access (MAHA)

An initiative to improve care in the community

Kathleen Healey, Rana K Zabad, Lufei Young, Aubrie Lindner, Nancy Lenz, Renee Stewart, Mary Charlton

Research output: Contribution to journalArticle

Abstract

Background: Caring for individuals with progressive, disabling forms of multiple sclerosis (MS) presents ongoing, complex challenges in health care delivery, especially access to care. Although mobility limitations represent a major hurdle to accessing comprehensive and coordinated care, fragmentation in current models of health care delivery magnify the problem. Importantly, individuals with disabling forms of MS are exceedingly likely to develop preventable secondary complications and to incur significant suffering and increased health care utilization and costs. Methods: A house call program, Multiple Sclerosis at Home Access (MAHA), was implemented. The program was designed to provide comprehensive services and prevent common complications. Key aspects included monthly house calls, continuity among providers, and a multidisciplinary team led by a comprehensivist, a provider bridging subspecialty and primary care. A total of 21 adult patients (Expanded Disability Status Scale score ≥7.5) completed 1 full year of the program. Results: During the 2-year preevaluation and postevaluation period, half of the hospital admissions were related to secondary and generally preventable complications. Aside from a single outlying individual important to the evaluation, in the year after program implementation, decreases were found in number of individuals hospitalized, hospitalizations/skilled facility admissions, and hospital days; the total number of overall emergency department (ED) visits decreased; and ED-only visits increased (ie, ED visits without hospital admission). Patient satisfaction reports and quality indicators were positive. Fifty percent of patients participated in supplementary televisits. Conclusions: This program evaluation suggests that a house call-based practice is a viable solution for improving care delivery for patients with advanced MS and disability.

Original languageEnglish (US)
Pages (from-to)101-112
Number of pages12
JournalInternational Journal of MS Care
Volume21
Issue number3
DOIs
StatePublished - May 1 2019

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House Calls
Multiple Sclerosis
Hospital Emergency Service
Patient Acceptance of Health Care
Mobility Limitation
Delivery of Health Care
Program Evaluation
Patient Satisfaction
Psychological Stress
Health Care Costs
Primary Health Care
Patient Care
Hospitalization

ASJC Scopus subject areas

  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Multiple Sclerosis at Home Access (MAHA) : An initiative to improve care in the community. / Healey, Kathleen; Zabad, Rana K; Young, Lufei; Lindner, Aubrie; Lenz, Nancy; Stewart, Renee; Charlton, Mary.

In: International Journal of MS Care, Vol. 21, No. 3, 01.05.2019, p. 101-112.

Research output: Contribution to journalArticle

Healey, Kathleen ; Zabad, Rana K ; Young, Lufei ; Lindner, Aubrie ; Lenz, Nancy ; Stewart, Renee ; Charlton, Mary. / Multiple Sclerosis at Home Access (MAHA) : An initiative to improve care in the community. In: International Journal of MS Care. 2019 ; Vol. 21, No. 3. pp. 101-112.
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