Patient-Reported Outcome Measures in Chronic Pain - Feasibility and Usability for Care Planning and Performance Measurement

National Committee For Quality Assurance, Washington DC

Investigators

Abstract

7. PROJECT SUMMARY/ABSTRACT Chronic pain is a common problem in primary care, particularly among vulnerable, medically underserved populations. Estimates suggest that 27 to 37% of the population have chronic pain, and the costs of pain have been estimated at $635 billion each year in medical treatment and lost productivity. The increase in opioid prescriptions for chronic pain --despite limited evidence for their long-term effectiveness?has contributed to marked increase in opioid misuse and related morbidity and mortality. Evidence-based guidelines for chronic pain call for a stepped approach to care, minimizing reliance on opioid medications, and emphasizing interdisciplinary treatments, but primary care clinicians do not consistently adhere to these prescribing practices. The National Pain Strategy calls for comprehensive and standardized assessments of patients with chronic pain and person-centered care planning, along with efforts to reduce unsafe opioid prescribing in primary care. More actively engaging patients in their own treatment may reduce mistrust, improve adherence to more effective care plans. Assessing functioning and conducting standardized care planning in the context of busy primary care settings requires overcoming challenges. Our ongoing work has shown that the use of patient reported outcome measures (PROMs) are valued by patients and can bring new insights about patient needs to the care team; however, the burden of data collection is great and using this information in developing care plans is a new process for patients and care teams. Sufficient data are needed to provide patients, clinicians and other members of the care team information on PROM results and to assess how they interpret the results both for the individual and for groups of patients. As a first step in an overall plan for improving outcomes for patients with chronic pain, this project will: 1) Demonstrate the feasibility of using patient portal and ?smartforms? in the electronic health record to facilitate the gathering and presentation of patient-reported functional data for chronic pain. 2) Evaluate alternative approaches for defining improvement based on data collected in clinical care as well as based on patient surveys in a subsample of patients. We will consider how changes vary based on patient demographic, clinical, and treatment characteristics. 3) Explore the usability of pain PROMs for care planning, quality improvement and performance measurement using interviews with patients, their clinicians and care team, and outside clinicians also trained in pain management. The National Committee for Quality Assurance (NCQA) will collaborate with the Weitzman Institute at Community Health Center, Inc., a statewide FQHC serving a diverse and vulnerable population. Findings will provide practical information to support care and inform policy efforts to improve pain care and performance measurement.