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

7.项目摘要/摘要 慢性疼痛是初级保健中的一个常见问题，特别是在脆弱的、医疗服务不足的人群中 人口。据估计，27%至37%的人口患有慢性疼痛，而疼痛的代价一直是 据估计，每年有6350亿美元的医疗费用和生产力损失。阿片类药物处方的增加 对慢性疼痛的治疗--尽管其长期有效性的证据有限--导致了 阿片类药物滥用及相关发病率和死亡率。慢性疼痛的循证指南要求阶梯式治疗 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始终如一地遵守这些处方做法。 国家疼痛战略呼吁对慢性疼痛患者进行全面和标准化的评估 以人为本的护理计划，同时努力减少初级保健中不安全的阿片类药物处方。更积极 让患者进行自己的治疗可能会减少不信任，提高对更有效护理计划的遵守。 在繁忙的初级保健环境中评估功能和进行标准化护理规划 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衡量标准 (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，使用这些信息来制定护理计划对患者来说是一个新的过程 和护理团队。需要足够的数据来为患者、临床医生和护理团队的其他成员提供 关于胎膜早破结果的信息，并评估他们如何解释个人和群体的结果 病人。作为改善慢性疼痛患者预后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患者门户和智能表单的可行性 促进收集和展示患者报告的慢性疼痛功能数据。 2)根据在临床护理中收集的数据以及 基于对部分患者进行的患者调查。我们将根据患者的不同来考虑变化情况 人口学、临床和治疗特征。 3)探索Pain Proms在护理计划、质量改进和绩效测量方面的可用性 通过采访患者、他们的临床医生和护理团队，以及外部临床医生也接受了疼痛方面的培训 管理层。 国家质量保证委员会(NCQA)将与社区的魏茨曼研究所合作 Health Center，Inc.，是一家全州范围的FQHC，服务于多样化和脆弱的人群。研究结果将提供实用的 支持护理的信息，并为改善疼痛护理和绩效衡量的政策努力提供信息。

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.