Dr. Helen Tremlett, research scientist with the UBC Hospital MS Clinic and Brain Research Centre at UBC Hospital and VCH Research Institute
This new research study was led by MS researchers Dr. Charity Evans (PhD), a former UBC post doctoral fellow, and Dr. Helen Tremlett (PhD), a member of the MS Research Group and Brain Research Centre at UBC Hospital and VCH Research Institute.
The retrospective observational study, published November 27th in the American Journal of Managed Care, examined patterns, temporal trends, and patient characteristics influencing hospital admissions in MS patients in British Columbia from 1986 to 2008. It is one of the first population-based studies in this area.
The researchers found the overall rate of admissions was 32 per 100 MS patients, with hospitalization rates decreasing over time, but length of stay increasing. They discovered 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.
“This study provides information needed for appropriate resource allocation planning as well as future studies examining the impact of various MS interventions and treatments,” says Dr. Tremlett, who is also an associate professor in the UBC Faculty of Medicine. “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 research team utilized data from 6601 patients within the British Columbia MS database 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.
A number of factors could be in play in terms of the changes observed, including the 1990s Canadian healthcare system reorganization, which 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. A number of changes in the management of MS over the past two decades may also be influencing 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 (CIHR) and National MS Society.
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.