title: A multidisciplinary clinic approach improves survival in ALS: a comparative study of ALS in Ireland and Northern Ireland.
abstract: BACKGROUND
  Amyotrophic lateral sclerosis (ALS) is a progressive debilitating neurodegenerative disease, with a life expectancy of 3-5 years from first symptom. There is compelling evidence that those who attend a multidisciplinary clinic experience improved survival. The purpose of the study was to explore the survival of patients with ALS ascertained through population-based Registers in the Republic of Ireland (RoI) and Northern Ireland (NI), and to determine whether centralisation of services confers advantage compared with community-based care supported by a specialist care worker.
  
  
  METHODS
  The island of Ireland is divided into two countries, RoI and NI, each with an independent healthcare system. Both countries have population-based ALS Registers with full ascertainment. Data from all 719 incident ALS cases from Ireland and NI, diagnosed between 1 January 2005 and 31 December 2010, were used in the analysis.
  
  
  RESULTS
  A survival benefit was identified for patients who attended the multidisciplinary ALS clinic in the RoI. (HR 0.59, 95% CI 0.49 to 0.71, p<0.001). This difference was preserved following multivariate analysis. A trend towards improved survival was noted for patients with ALS from NI when compared with RoI patients who did not attend a multidisciplinary clinic.
  
  
  CONCLUSIONS
  Centralised multidisciplinary care confers a survival advantage for patients with ALS and is superior to devolved community-based care. We propose that multiple decision-making processes within a multidisciplinary setting lead to an enriched set of clinical encounters for the patient and carer that enhances clinical outcome.
authors.affiliation: Department of Academic Neurology, Trinity Biomedical Sciences Institute Trinity College, Dublin, Ireland.
authors.forename: James
authors.initials: J
authors.lastname: Rooney
authors.affiliation: Department of Academic Neurology, Trinity Biomedical Sciences Institute Trinity College, Dublin, Ireland.
authors.forename: Susan
authors.initials: S
authors.lastname: Byrne
authors.affiliation: Department of Academic Neurology, Trinity Biomedical Sciences Institute Trinity College, Dublin, Ireland.
authors.forename: Mark
authors.initials: M
authors.lastname: Heverin
authors.affiliation: Department of Academic Neurology, Trinity Biomedical Sciences Institute Trinity College, Dublin, Ireland.
authors.forename: Katy
authors.initials: K
authors.lastname: Tobin
authors.affiliation: Department of Neurology, Royal Victoria Hospital, Belfast, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Dick
authors.affiliation: Department of Neurology, Royal Victoria Hospital, Belfast, UK.
authors.forename: Colette
authors.initials: C
authors.lastname: Donaghy
authors.affiliation: Department of Academic Neurology, Trinity Biomedical Sciences Institute Trinity College, Dublin, Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: Hardiman
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D000690:Amyotrophic Lateral Sclerosis / Q000401:mortality*; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D010348:Patient Care Team
keywords: ALS; EPIDEMIOLOGY; MOTOR NEURON DISEASE