title: A home-based comprehensive care model in patients with Multiple Sclerosis: A study pre-protocol.
abstract: Background Disability is prevalent in individuals with multiple sclerosis (MS), leading to difficulty in care access, significant caregiver burden, immense challenges in self-care and great societal burden.  Without highly coordinated, competent and accessible care, individuals living with progressive MS experience psychological distress, poor quality of life, suffer from life-threatening complications, and have frequent but avoidable healthcare utilizations. Unfortunately, current healthcare delivery models present severe limitations in providing easily accessible, patient-centered, coordinated comprehensive care to those with progressive MS. We propose a home-based comprehensive care model (MAHA) to address the unmet needs, challenges, and avoidable complications in individuals with progressive MS with disabling disease. Objective The article aims to describe the study design and methods used to implement and evaluate the proposed intervention.   Method The study will use a randomized controlled design to evaluate the feasibility of providing a 24-month, home-based, patient-centered comprehensive care program to improve quality of life, reduce complications and healthcare utilizations overtime (quarterly) for 24 months. A transdisciplinary team led by a MS-Comprehensivist will carry out this project. Fifty MS patients will be randomly assigned to the intervention and usual care program using block randomization procedures. We hypothesize that patients in the intervention group will have fewer complications, higher quality of life, greater satisfaction with care, and reduced healthcare utilization. The proposed project is also expected to be financially sustainable in fee-for-service models but best suited for and gain financial success in valued-based care systems.   Discussion This is the first study to examine the feasibility and effectiveness of a home-based comprehensive care management program in MS patients living with progressive disability. If successful, it will have far-reaching implications in research, education and practice in terms of providing high quality but affordable care to population living with severe complex, disabling conditions.
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Lincoln, Nebraska, USA.
authors.forename: Lufei
authors.initials: L
authors.lastname: Young
authors.affiliation: Multiple Sclerosis Program, Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Healey
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Charlton
authors.affiliation: Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Kendra
authors.initials: K
authors.lastname: Schmid
authors.affiliation: Multiple Sclerosis Program, Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Rana
authors.initials: R
authors.lastname: Zabad
authors.affiliation: Department of Family Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wester
keywords: disability; healthcare utilization; home-based care; multiple sclerosis; symptom management; value-based care