Effects of a Digital Care Pathway for Multiple Sclerosis:Observational Study

Background: Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS)to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease. Objective: This study investigated the MS DCP user behavior and its impact on patient education-mediated changes in healthcare use, patient-perceived impact of MS on psychological and physical functional health, and patient satisfaction. Methods: We collected data from the service launch in March 2020 until the end of 2022 (observation period). The number ofusers, user logins, and their timing and messages sent were collected. The association of the DCP on health care use was studiedin a case-control setting in which patients were allowed to freely select whether they wanted to use the service (DCP group n=63)or not (control group n=112). The number of physical and remote appointments either to a doctor, nurse, or other services wereconsidered in addition to emergency department visits and inpatient days. The follow-up time was 1 year (study period).Furthermore, a subgroup of 36 patients was recruited to fill out surveys on net promoter score (NPS) at 3, 6, and 12 months, andtheir physical and psychological functional health (Multiple Sclerosis Impact Scale) at 0, 3, 6, and 12 months. Results: During the observation period, a total of 225 patients had the option to use the service, out of whom 79.1% (178/225)logged into the service. On average, a user of the DCP sent 6.8 messages and logged on 7.4 times, with 72.29% (1182/1635) oflogins taking place within 1 year of initiating the service. In case-control cohorts, no statistically significant differences betweenthe groups were found for physical doctors'appointments, remote doctors'contacts, physical nurse appointments, remote nursecontacts, emergency department visits, or inpatient days. However, the MS DCP was associated with a 2.05 (SD 0.48) visitincrease in other services, within 1 year from diagnosis. In the prospective DCP-cohort, no clinically significant change wasobserved in the physical functional health between the 0 and 12-month marks, but psychological functional health was improvedbetween 3 and 6 months. Patient satisfaction improved from the NPS index of 21 (favorable) at the 3-month mark to the NPSindex of 63 (excellent) at the 12-month mark. Conclusions: The MS DCP has been used by a majority of the people with MS as a complementary service to regular operations,and we find high satisfaction with the service. Psychological health was enhanced during the use of MS DCP. Our results indicatethat DCPs hold great promise for managing chronic conditions such as MS. Future studies should explore the potential of DCPsin different health care settings and patient subgroups.