title: Stepped care model of pain management and quality of pain care in long-term opioid therapy.
abstract: Successful organizational improvement processes depend on application of reliable metrics to establish targets and to monitor progress. This study examined the utility of the Pain Care Quality (PCQ) extraction tool in evaluating implementation of the Stepped Care Model for Pain Management at one Veterans Health Administration (VHA) healthcare system over 4 yr and in a non-VHA Federally qualified health center (FQHC) over 2 yr. Two hundred progress notes per year from VHA and 150 notes per year from FQHC primary care prescribers of long-term opioid therapy (>90 consecutive days) were randomly sampled. Each note was coded for the presence or absence of key dimensions of PCQ (i.e., pain assessment, treatment plans, pain reassessment/outcomes, patient education). General estimating equations controlling for provider and facility were used to examine changes in PCQ items over time. Improvements in the VHA were noted in pain reassessment and patient education, with trends in positive directions for all dimensions. Results suggest that the PCQ extraction tool is feasible and may be responsive to efforts to promote organizational improvements in pain care. Future research is indicated to improve the reliability of the PCQ extraction tool and enhance its usability.
authors.affiliation: Pain Research, Informatics, Multimorbidities and Education Center, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, and Yale School of Medicine, New Haven, CT;
authors.forename: Brent A
authors.initials: BA
authors.lastname: Moore
authors.forename: Daren
authors.initials: D
authors.lastname: Anderson
authors.forename: Lindsey
authors.initials: L
authors.lastname: Dorflinger
authors.forename: Ianita
authors.initials: I
authors.lastname: Zlateva
authors.forename: Allison
authors.initials: A
authors.lastname: Lee
authors.forename: Wesley
authors.initials: W
authors.lastname: Gilliam
authors.forename: Terrence
authors.initials: T
authors.lastname: Tian
authors.forename: Khushbu
authors.initials: K
authors.lastname: Khatri
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Ruser
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care; D015203:Reproducibility of Results; D013997:Time Factors; D014481:United States; D014728:Veterans
chemical_list: D000701:Analgesics, Opioid
keywords: Veterans; chart extraction; chart review; chronic pain; organizational improvement; pain; pain care; pain management; primary care; quality indicators