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.

Public Health Relevance

Chronic pain affects an estimated 27- 37% of adults, accounts for $635 billion in medical treatment and lost productivity, and is connected to the rising rate of opioid medication overuse and deaths due to overdose. Capturing patient perspectives on how pain interferes with functioning could provide the patient and the care team a valid and standardized approach for assessment that could be used to guide the treatment plan and to assess individual improvement; these results could also be used to assess healthcare organizations. This project will demonstrate the feasibility and usability of incorporating standardized assessment of functional status in routine care for chronic pain.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Healthcare Effectiveness and Outcomes Research (HEOR)
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Basu, Jayasree
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National Committee for Quality Assurance
United States
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