American Academy of Neurology Institute Quality Improvement Update for MS

The American Academy of Neurology Institute released a 2020 quality measurement set to improve care outcomes for patients with multiple sclerosis.

The American Academy of Neurology Institute (AANI) released a quality measurement set 2020 update aimed at improving care delivery and outcomes for patients with multiple sclerosis (MS), according to an update published in Neurology.

A chronic health condition, MS has been diagnosed at a higher rate than predicted in 2010 and remains one of the costliest medical conditions. About 914,000 individuals were living with MS in the United States in 2017, and the cost for care was $13.9 billion in 2016. In order to assure that patients with MS are receiving the best care, the AANI reviews its quality measurement recommendations triennially.

On the basis of a literature search and an open public comment period, the AANI committee agreed on 6 measures to be included in the 2020 update and retired 7 measures.

For patients with established disease and who have been assessed by magnetic resonance imaging (MRI) during the past 24 months, the committee recommended continued MRI monitoring. This measure was intended to address a gap in care, assure that patients are receiving the most appropriate treatment, and to allow for timely modifications when necessary.

In their update, the committee also recommended that patients treated with disease modifying treatments be monitored for side effects and compliance. Current recommendations are for monitoring at the beginning of the treatment course; however, continued monitoring may result in greater improvements to quality of life.

Screening for bowel, bladder, and sexual dysfunction should occur yearly as up to 90% and 80% of men and women, respectively, with MS experience sexual dysfunction. These symptoms are often overlooked and can have a large impact on mental health and quality of life.

Patients with MS should also be screened for cognitive impairments and fatigue as up to 70% and 80% of patients with MS experience cognitive deficits and chronic fatigue, respectively. The update authors cautioned that impairments should be screened for using MS-specific instruments as standard neurologic examinations are not sensitive enough for patients with MS and that for fatigue, the cause for patients with MS is often multifactorial.

Finally, the committee recommended that patients with MS receive exercise and physical activity counseling in order to optimize physical health.

The retired measures comprised aspects of MS diagnosis, the Disability Scale, fall risk screening, the fatigue outcome, depression screening, and baseline quality of life assessment.

The AANI committee concluded that these quality assurance measures will improve delivery of care and neurologic outcomes for patients with MS.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Rae-Grant A, Amezcua L, English J, et al. Quality Improvement in Neurology: Multiple Sclerosis Quality Measurement Set 2020 Update. Neurology. 2021;97(3):134-141. doi:10.1212/WNL.0000000000012124