Hospital admissions for multiple sclerosis (MS) have decreased over time, but the length of stay has increased, according to new research led by Charity Evans, a former postdoctoral fellow with Helen Tremlett, an Associate Professor in the Division of Neurology.
The retrospective observational study, which was published in The American Journal of Managed Care, examined patterns, temporal trends, and patient characteristics influencing hospital admissions in MS patients in BC from 1986 to 2008. It is one of the first population-based studies in this area.
“We found that the overall rate of admissions was 32 per 100 MS patients,” says Dr. Evans, the study’s lead author and who is now an Assistant Professor at the University of Saskatchewan. “We also found that hospitalization rates decreased over time, but interestingly the length of stay has increased.”
The researchers found that higher admission rates were associated with older age, the presence of a primary progressive MS disease course, and a longer disease duration.
Hospital admissions are measured outcomes in both clinical trials and observational studies, and are often considered important surrogate measures for disease progression and overall utilization of healthcare resources. Data from 6,601 patients within the British Columbia MS database were linked with the BC Ministry of Health’s hospital registry administrative data from 1986 (the first full year both hospital and registry data were available) until 2008, and included admission and discharge dates, length of stay, primary reason for admission, and up to 24 additional diagnostic classifications. Only admissions occurring after onset of MS symptoms, as determined by an MS neurologist and recorded in the database, were included in the analyses. Linkage was facilitated by Population Data BC.
Helen Tremlett
“Our study provides information that is needed for appropriate resource allocation planning and future studies examining the impact of various MS interventions and treatments,” says Dr. Tremlett, a member of the Brain Research Centre of UBC and the Vancouver Coastal Health Research Institute. “However, caution is needed when comparing our results to those obtained by examining data from other countries and healthcare systems because of differences in healthcare system use, practices, and funding.”
The results of the study were likely influenced by the Canadian healthcare system reorganization, which began in the 1990s, and resulted in a reduction in the number of hospital beds available for inpatient admissions, as well as advances in technology that now allow many services to be performed on an outpatient level. As well, a number of changes in the management of MS over the past two decades may have influenced hospital admission patterns, including advancements in the recognition and earlier diagnosis of the disease, and the introduction of new drugs, including the first disease-modifying drugs such as the beta interferons and glatiramer acetate, which are aimed at reducing relapses and slowing disease progression.
The study was funded by the Canadian Institutes of Health Research and National MS Society. The study sponsors had no role in the study design, data collection, data analysis, interpretation of results, writing of this manuscript, or decision to submit. Other co-authors on the study are Elaine Kingwell (UBC and VCH Research Institute), Feng Zhu (UBC and VCH Research Institute), Joel Oger (UBC and VCH Research Institute), and Yinshan Zhao (UBC). The authors gratefully acknowledge the BC MS Clinic neurologists who contributed through patient examination and data collection.