Enhancing Geriatric Pain Care with Contextual Patient Generated Profiles

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Background: Pain is not an inevitable or normal part of aging. However, chronic pain for geriatric patients is widespread, occurring in approximately 50% of community dwelling adults age 65 or over. Ineffectively treated chronic pain patients are at risk for poorer quality of life and functional decline. Risk for addiction to opioids prescribed for pain are increasingly recognized for geriatric pain patients. Evidence suggests that pain in geriatrics patients is common, challenging to assess, and requires a whole-person approach to diagnosis, treatment and monitoring. The goal of this study is to refine and test an approach to create contextual Patient Generated Data (PGD) profiles to guide geriatric pain care. Significance/Impact: Our proposed work will contribute to effective pain management and delivery of patient centered care. The proposed work aligns with many areas of high priority for VA including aging Veterans, pain management, informatics, and whole health and has implications for the redesign of the Electronic Health Record (EHR). Innovation: This study includes an innovative approach to patient centered care by examining contextual PGD contribution in depth in a vulnerable Veteran population with chronic pain. Specific Aims: Aim 1: Prioritize content for contextual PGD profiles to support patient-centered care for geriatric Veterans with chronic pain. Aim 2: Develop a prototype contextual PGD display and evaluate its usability. Aim 3: Examine the impact of contextual PGD profile displays on patient adherence, satisfaction, and shared- decision making in a randomized trial. Methodology: The study population is Veterans with chronic pain, caregivers involved in their daily lives, and the primary care clinicians who treat these Veterans in primary care or geriatrics clinics in both urban and rural settings. Clinicians will include physicians, nurse practitioners, nurses, social workers, psychologists and other relevant primary care team members. This is a mixed methods study incorporating focus groups with clinicians and with Veteran patients and caregivers and systematic evaluation of iterative contributions of contextual PGD to develop and optimize methods for Veterans to contribute contextual PGD. In addition, VHA clinicians in primary care and geriatrics clinics will participate in a nominal group technique in which they will review contextual PGD elements and vote on how important these elements are for their role as a clinician and in general for the patients’ pain management care. An additional group of PACT members will engage in a card sort reporting in more detail on the relevance of particular contextual PGD elements. There will be a randomized comparison at the patient level comparing patient visits that include contextual PGD and those that do not. Primary outcomes include appropriateness of clinical decisions documented in the chart and rated by expert clinicians and an assessment of patient satisfaction with pain management at follow up. Secondary outcomes include shared decision making in the visit. Next Steps/Implementation: Our project includes multiple assessments designed to improve collection of contextual PGD to inform future implementation, working closely with our operational partners the Offices of Healthcare Informatics, Connected Care and Patient Centered Care and Cultural Transformation.