title: Patient-reported outcomes in a large community-based pain medicine practice: evaluation for use in phenotype modeling.
abstract: BACKGROUND
  An academic, community medicine partnership was established to build a phenotype-to-outcome model targeting chronic pain. This model will be used to drive clinical decision support for pain medicine in the community setting. The first step in this effort is an examination of the electronic health records (EHR) from clinics that treat chronic pain. The biopsychosocial components provided by both patients and care providers must be of sufficient scope to populate the spectrum of patient types, treatment modalities, and possible outcomes.
  
  
  METHODS
  The patient health records from a large Midwest pain medicine practice (Michigan Pain Consultants, PC) contains physician notes, administrative codes, and patient-reported outcomes (PRO) on over 30,000 patients during the study period spanning 2010 to mid-2014. The PRO consists of a regularly administered Pain Health Assessment (PHA), a biopsychosocial, demographic, and symptomology questionnaire containing 163 items, which is completed approximately every six months with a compliance rate of over 95%. The biopsychosocial items (74 items with Likert scales of 0-10) were examined by exploratory factor analysis and descriptive statistics to determine the number of independent constructs available for phenotypes and outcomes. Pain outcomes were examined both in the aggregate and the mean of longitudinal changes in each patient.
  
  
  RESULTS
  Exploratory factor analysis of the intake PHA revealed 15 orthogonal factors representing pain levels; physical, social, and emotional functions; the effects of pain on these functions; vitality and health; and measures of outcomes and satisfaction. Seven items were independent of the factors, offering unique information. As an exemplar of outcomes from the follow-up PHAs, patients reported approximately 60% relief in their pain. When examined in the aggregate, patients showed both a decrease in pain levels and an increase in coping skills with an increased number of visits. When examined individually, 80-85% of patients presenting with the highest pain levels reported improvement by approximately two points on an 11-point pain scale.
  
  
  CONCLUSIONS
  We conclude that the data available in a community practice can be a rich source of biopsychosocial information relevant to the phenotypes of chronic pain. It is anticipated that phenotype linkages to best treatments and outcomes can be constructed from this set of records.
authors.affiliation: Biomedical Research Informatics Core, Clinical and Translational Sciences Institute, Michigan State University, West Fee Hall, East Lansing, MI, USA. David.Juckett@hc.msu.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Juckett
authors.affiliation: Michigan Pain Consultants, PC, ProCare Systems, Inc., Grand Rapids, MI, USA.
authors.forename: Fred N
authors.initials: FN
authors.lastname: Davis
authors.affiliation: Michigan Pain Consultants, PC, ProCare Systems, Inc., Grand Rapids, MI, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Gostine
authors.affiliation: Biomedical Research Informatics Core, Clinical and Translational Sciences Institute, Michigan State University, West Fee Hall, East Lansing, MI, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Reed
authors.affiliation: ProCare Systems, Inc., Grand Rapids, MI, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Risko
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000628:therapy; D003153:Community Health Services / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D015146:Midwestern United States; D059408:Pain Management / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D010641:Phenotype; D011331:Private Practice / Q000706:statistics & numerical data