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

7.项目总结/摘要 慢性疼痛是初级保健中的常见问题，特别是在弱势群体中，医疗服务不足 人口。据估计，27%至37%的人口患有慢性疼痛，而疼痛的成本一直是 据估计，每年在医疗和生产力损失方面的损失高达6350亿美元。阿片类药物处方的增加 慢性疼痛-尽管其长期有效性的证据有限-已导致 阿片类药物滥用及相关的发病率和死亡率。慢性疼痛的循证指南需要一个逐步的 护理方法，尽量减少对阿片类药物的依赖，并强调跨学科治疗，但 初级保健临床医生并不总是坚持这些处方实践。 国家疼痛战略要求对慢性疼痛患者进行全面和标准化的评估， 以人为本的护理规划，沿着努力减少初级保健中不安全的阿片类药物处方。更积极 让患者参与自己的治疗可以减少不信任，提高对更有效护理计划的依从性。 在忙碌的初级保健环境中评估功能并进行标准化护理计划 需要克服挑战。我们正在进行的工作表明，使用患者报告的结果指标 （PROM）受到患者的重视，可以为护理团队带来关于患者需求的新见解;然而， 数据收集的负担很大，使用这些信息制定护理计划对患者来说是一个新的过程 护理团队需要足够的数据，以向患者、临床医生和护理团队的其他成员提供 关于PROM结果的信息，并评估他们如何解释个人和群体的结果， 患者作为改善慢性疼痛患者结局的总体计划的第一步，该项目将： 1)论证在电子健康记录中使用病人入门网站和“smartforms”的可行性， 便于收集和呈现患者报告的慢性疼痛功能数据。 2)根据临床护理中收集的数据，评估用于定义改善的替代方法，以及 基于对患者子样本的患者调查。我们将考虑如何根据患者的变化而变化 人口统计学、临床和治疗特征。 3)探索疼痛PROM在护理计划、质量改进和绩效测量中的可用性 通过与患者、他们的临床医生和护理团队以及接受过疼痛培训的外部临床医生的访谈， 管理 国家质量保证委员会（NCQA）将与社区的韦茨曼研究所合作， 健康中心公司，一个全州范围的社区卫生服务中心，为多样化和弱势群体服务。调查结果将提供实用 信息，以支持护理和告知政策努力，以改善疼痛护理和性能测量。

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.