At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 15, Fred Davis, MD, clinical assistant professor in the college of human medicine at Michigan State University, shared the importance of measuring clinical outcomes for pain management.
Dr. Davis began his presentation by reminding the audience why measuring clinical outcomes for pain management is important. He used a quote from the Institute of Medicine report "Relieving Pain in America" from June 2011. "Chronic pain affects an estimated 116 million American adults — more than the total affected by heart disease, cancer and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity."
One of the reasons this is under the radar is because pain hides behind a lot of other diseases, said Dr. Davis. In addition, with the unsustainable growth and lack of healthcare access for 30 to 40 million people, there are great disparities in healthcare. This is changing the way we look at healthcare. As a consequence, we are seeing the following emerging healthcare trends.
Emerging trends
1. Population health management — organizations caring for populations of patients
2. Disease management — care over the course of a disease process
3. Value-based healthcare — need to demonstrate the value of care on overall quality of life and wellbeing
In order to address these trends, Dr. Davis observed that we are seeing a transition from fee-for-service to bundled payments by all stakeholders. There is also an increasing need for accountability and shared risk and specialty services to integrate with the organizations caring for populations of patients.
"Health information technology will also play a key role. Emerging models of care require workflow redesign and change management. [HIT] provides foundational support to enable workflow and process changes that will foster stronger relationships and healthcare experiences," said Dr. Davis.
Benefits
Dr. Davis then addressed the five benefits providers and clinicians receive from measuring clinical outcomes:.
- 1. Provides a way to demonstrate the effectiveness of care.
- 2. Provides a way to contribute to clinical effectiveness research using the voices of patients.
- 3. Ability to advocate on behalf of patients and practice.
- 4. Ability to bring tools to the table that can be useful to larger organizations for potential integration.
- 5. Enables a voice in the future.
In order to measure clinical outcomes and achieve these above benefits, Dr. Davis believes a digital toolbox should be developed. The digital toolbox should comprise a patient assessment matrix, a pain health assessment, a summary page and clinical performance summaries. These elements are detailed below:
1. Patient assessment matrix — disease burden risk score completed by physician.
2. Pain health assessment — patient reported self-assessment tool.
3. Summary page — a dashboard showing real-time data for patient care.
4. Clinical performance summaries — reports that show results of providers and practice care management.
"If we, as clinicians, are going to be responsible for the outcomes of treatment, there needs to be a tool that assesses the relative disease burden and risk. This must be taken into account; otherwise, there will be a trend toward avoiding treatment of high risk patients," said Dr. Davis.
Future uses and outcomes
"This is a constantly evolving system. As technology has advanced with mobile devices and use of tablets, measuring clinical outcomes is becoming easier," said Dr. Davis. For this reason, the future of measuring clinical outcomes for pain management will continue to change. Here are some of the elements he believes the healthcare industry can expect for clinical outcomes in pain management:
- 1. To move toward best clinical practices
- 2. Use of data for research purposes
- 3. Use of clinical and practice management data to move to "value-based care"
- 4. Use of data to support referrals/reimbursement based on best value-based care
- 5. Integration of data collection between clinical and practice management systems
- 6. Integration of data across accountable care settings over the course of the diseases
"We are ultimately using this to get to the Holy Grail, which is value-based care," said Dr. Davis.