New SPH Immunotherapy in Neurology (SPIN Centre) brings value-based health care to patients

Innovarium element

Department of Medicine Innovation Platform

Project initiators

Drs. Kristine Chapman and Katie Beadon

Impact

People living with autoimmune neuromuscular disorders are now able to access critical treatments from home, rather than hospital. This significantly improves their quality of life.

People living with inflammatory disorders of the muscle and nerve can now receive critical treatments at home rather than visiting a hospital. They also have access to coordinated care through the St. Paul’s Immunotherapy in Neurology (SPIN) Centre. The Centre takes a value-based care approach, meaning the focus is on developing a care plan that incorporates what matters most to the individual patient. It is the first clinic of its kind in B.C.

The challenge 

Autoimmune neuromuscular diseases are caused by an overactive immune system that attacks a person’s muscles or nerves. Symptoms include numbness in limbs and burning sensations in the nerves. Many patients develop muscle weakness that leaves them unable to climb stairs, participate in sports or even walk. In some conditions such as myasthenia gravis,  if severe, the throat and respiratory muscles can be affected and the person can have difficulty breathing or swallowing.

A common treatment for these conditions is intravenous immunoglobulin therapy (IVIg) every few weeks. Immunoglobulins are a blood product that carry antibodies to fight germs or disease as well as modulate the immune system.  

Traditionally, treatment has involved a trip to the hospital for an infusion that can take four to eight hours. This means a day off work or time away from other activities and, depending on where the patient lives, travel to a hospital that offers the treatment.

The solution

In other jurisdictions, people with autoimmune neuromuscular diseases have been able to access immunoglobulin treatments at home. In B.C. a lack of infrastructure to transition and monitor patients in the community led to uneven access to this treatment and less than optimal care for some patients. 

Dr. Kristine Chapman, head of the Division of Neurology at Providence Health Care and Dr. Katie Beadon, a neurologist with the SPIN Centre, wanted to change that. A consolidated clinic would bring together a team of subspecialists and specialized nursing support to see patients in person and virtually, improving access to home therapy and "wrap around care".  

The proposal for the SPIN Centre was a fit for the Department of Medicine Innovation Platform, which is designed to help physicians develop and implement innovative and transformational projects that are aligned with Providence Health Care’s strategic plan, as well as the St. Paul’s Hospital redevelopment plan. 

Dept of Medicine Innovation funded the pilot project in 2021, along with grant support.  

The impact 

Since the launch of the SPIN Centre, more than 90 per cent of patients have transferred to at-home treatment. Not only do many patients prefer to take their treatment at home, but it also frees up beds in medical short stay for patients who really need in-hospital care.

In addition, all patients with autoimmune neuromuscular disorders, whether they access treatment at home or in hospital, are able to work with clinicians to design a treatment program, including lifestyle, drug and immunoglobulin therapy to help them achieve their care goals. This approach allows the clinical team to track improvements or get early flags if something is going off track.

Based on the success of the pilot at SPH, the Immunotherapy in Neurology and home immunoglobulin therapy program will expand to a regional program in 2025. Our modeling estimates an opportunity cost savings of over $1 million per year, which translates to increased bed availability for other patients.