Maximize the Power of Data in Pain Care
When improving the quality of pain care, health care organizations can be tempted to start making changes, but having appropriate outcomes data ensures that the efforts are effective, sustainable and evidence-based.
“You need to have a handle on outcomes before you start changing processes,” noted former U.S. Army Surgeon General Eric Schoomaker, MD, PhD.
Improving chronic pain management requires using all the tools in our toolbox, including outcomes and measurement data. Overcoming challenges in data collection, focusing on patient-centered data, and using valid and consistent tools are three important components of the data picture.
These are just a few of the lessons being learned in Samueli Institute’s Chronic Pain Collaborative in which participants learn state of the art approaches to improve integrative pain management.
Challenge of Integrative Pain Management
Showing improvements in Integrative Pain Management is challenging. Integrative treatments are currently used as a treatment of last resort. As with other medical conditions, history has shown us that it is much better to prevent than to treat the condition. Therefore, those who are receiving the treatment are less likely to respond because they are further along in the pain continuum.
In the field of research, this is called a sampling bias. Sampling bias means that the participants being studied do not reflect the characteristics of the population which is being tested.
“We need to get our patients into integrative treatment earlier so we can see better outcomes. Including it early in treatment helps prevent the helplessness and hopelessness cycle that can prevent our patients from improving,” says Bonnie Sakallaris, RN, PhD, Vice President of Samueli Institute.
But it’s not just important TO collect data; it’s more WHAT data you collect.
Collecting Valid and Consistent Data
“Large amounts of valid and consistent data is very powerful in determining what works in the area of pain care. You can’t compare efficacy if you don’t have good data,” says Bonnie Sakallaris, PhD, RN, Vice President, Samueli Institute.
Consistent and valid data minimizes issues with evaluating success.
Several members of the Chronic Pain Collaborative implemented a validated assessment scale developed by the military called PASTOR[i].
PASTOR (Pain Assessment Screening Tool and Outcomes Registry) was developed by the military on the recommendation of the Army Pain Management Task Force to optimize quality of life for patients living with acute and chronic pain.
To develop this tool, the Pain Management Task Force leveraged the NIH’s investment in building the Patient-Reported Outcomes Measurement Information System (PROMIS®). PASTOR enhances the clinical encounter and provides data for comprehensive evaluations of treatment effectiveness. It’s available via REDCap, which is a secure web application for building and managing online surveys and databases.
Improving Patient Care through PASTOR
Madigan Army Medical Center’s Interdisciplinary Pain Management Center (IPMC) began piloting the online outcomes pain measurement tool earlier this year to improve their patient care. Patients either filled it out at home online or at kiosks in the pain clinic. It took 20 minutes the first time and filling it out every four weeks at follow-ups took about 16 minutes.
The provider then receives a three-page report with a visual dashboard and which looks at the whole person as it screens for post traumatic stress, depression, anxiety, sleep dysfunction, activity, mood, stress and alcohol usage.
In the short-term, providers found the tool to be effective and began using this holistic report as a way to talk with their patients about their pain goals, care and outcomes.
In the long-term, the clinic is excited to use the data to help determine their efficacy of care.
“By collecting this data, we can help understand what types of patients or which diagnoses are more likely to improve, which are less likely and who should we treat via different avenues,” said Diane Flynn, MD, Primary Care Pain Advisor for the Interdisciplinary Pain Management Clinic at the Madigan Army Medical Center (IPMC).
An Opportunity for Change
Another team noted that they, too, had an opportunity to improve their outcomes strategy to show the results of their work.
“We realized that we needed to show the effect of our work. We weren’t doing that enough before.” -Collaborative participant
Exploration uncovered that the batteries of tests were overlapping, repetitive and not very meaningful to their patients.
The team changed their measurement strategy; they added some and removed others. The new outcomes were still comprehensive, but less burdensome for patients – decreasing the time taking assessments from 60 minutes to 25 minutes. They also saw the value of adding a one-on-one consultation to go over the assessment findings with the patients to help judge progress at several time-points along the treatment.
The team received advice and input from other groups participating in the collaborative as well as experts in the field of pain and research as part of the 9-month collaborative process.
Pain practitioners are trained to work towards a goal of decreasing pain levels and increasing quality of life. But what often gets overlooked are the patient’s goals.
“Determining what the patient wants and needs out of the care is essential. Patients need to create their own outcomes and the medical team helps them to quantify it and work towards this goal,” says Wayne B Jonas, MD, President and CEO of Samueli Institute.
His work in the area of patient-centered approaches to care helped to re-structure his concept of assessment.
Optimizing care requires allowing patients to choose their own outcomes of focus. Having the patient establish an outcome of focus is part of a chain of events that helps empower a patient. If a patient wants to go on a trip, or sit on the floor with their grandkids, that becomes the goal and the treatment is aimed at helping the patient achieve that goal.
“Engaging the patient prevents them from being a victim of their care. The patient becomes an active member of their pain care team and is more incentivized to engage in self-care and adhere to treatment,” said Sandi Gordon, Senior Program Manager, Samueli Institute.
Collecting patient-focused data rather than pain-focused data is an important strategy in starting to turn the tide in pain management.
Integrative Pain Management
We love data here at Samueli Institute. So when we have an opportunity to share this passion while also improving the health of the nation we are in our sweet spot. Participants in the chronic pain collaborative learned to use data to improve their chronic pain programs.
Samueli Institute is currently seeking participants for the next learning community on chronic pain. Learn more.