title: Improving pain care through implementation of the Stepped Care Model at a multisite community health center.
abstract: OBJECTIVE
  Treating pain in primary care is challenging. Primary care providers (PCPs) receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM) at a large, multisite Federally Qualified Health Center.
  
  
  METHODS
  The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention) cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence.
  
  
  RESULTS
  Providers' pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009). There was no significant change in opioid prescribing.
  
  
  CONCLUSIONS
  Implementation of the SCM-PM resulted in clinically significant improvements in several quality of pain care outcomes. These findings, if sustained, may translate into improved patient outcomes.
authors.affiliation: Weitzman Institute, Community Health Center, Inc., Middletown.
authors.forename: Daren R
authors.initials: DR
authors.lastname: Anderson
authors.affiliation: Weitzman Institute, Community Health Center, Inc., Middletown.
authors.forename: Ianita
authors.initials: I
authors.lastname: Zlateva
authors.affiliation: UCONN Health Disparities Institute, University of Connecticut, Farmington.
authors.forename: Emil N
authors.initials: EN
authors.lastname: Coman
authors.affiliation: Weitzman Institute, Community Health Center, Inc., Middletown.
authors.forename: Khushbu
authors.initials: K
authors.lastname: Khatri
authors.affiliation: Weitzman Institute, Community Health Center, Inc., Middletown.
authors.forename: Terrence
authors.initials: T
authors.lastname: Tian
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
keywords: FQHC; chronic pain; community health; primary care; quality improvement