Identifying Predictors of Recommendations for and Participation in Multimodal Nonpharmacological Treatments for Chronic Pain Using Patient-Reported Outcomes and Electronic Medical Records

Abstract Objective High-quality chronic pain care emphasizes multimodal treatments that include medication and nonpharmacological treatments. But it is not clear which patients will participate in nonpharmacological treatments, such as physical therapy or mental health care, and previous research has shown conflicting evidence. Methods We used the Patient Outcomes Repository for Treatment (PORT) registry, which combines patient-reported outcomes data with electronic medical records. In this retrospective observational study, we performed two separate multinomial regression analyses with feature selection to identify PORT variables that were predictive of 1) recommendation of a nonpharmacological treatment by the provider and 2) patient participation in nonpharmacological treatments. Two hundred thirty-six patients were recommended (REC) or not recommended (NO REC) a nonpharmacological treatment, and all REC patients were classified as participating (YES) or not participating (NO) in the recommendations. Results Female gender and a diagnosis of Z79 “Opioid drug therapy” were significant positive and negative predictors of nonpharmacological treatment recommendations, respectively. Schedule II opioid use at initial presentation and recommendations for rehabilitation therapy were significant predictors of nonparticipation. Conclusions Patients using opioids are less likely to be recommended nonpharmacological treatments as part of multimodal chronic pain care and are less likely to participate in nonpharmacological treatments once recommended. Males are also less likely to be recommended nonpharmacological treatments. Patients referred for rehabilitation therapies are less likely to comply with those recommendations. We have identified patients in vulnerable subgroups who may require additional resources and/or encouragement to comply with multimodal chronic pain treatment recommendations.

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Methodologic Considerations for Collecting Patient-reported Outcomes from Unselected Surgical Patients

Anesthesiology ◽

10.1097/aln.0000000000001217 ◽

2016 ◽

Vol 125 (3) ◽

pp. 495-504 ◽

Cited By ~ 19

Author(s):

Daniel L. Helsten ◽

Arbi Ben Abdallah ◽

Michael S. Avidan ◽

Troy S. Wildes ◽

Anke Winter ◽

...

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Patient Reported Outcomes ◽

Query Language ◽

Preoperative Assessment ◽

Surgical Patients ◽

Clinical Workflow ◽

Patient Reported ◽

The Impact ◽

E Mail

Abstract Background The impact of surgery on health is only appreciated long after hospital discharge. Furthermore, patients’ perceptions of postoperative health are not routinely ascertained. The authors instituted the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) registry to evaluate patients’ postoperative health based on patient-reported outcomes (PROs). Methods This article describes the methods of establishing the SATISFY-SOS registry from an unselected surgical population, combining perioperative PROs with information from electronic medical records. Patients enrolled during their preoperative visit were surveyed at enrollment, 30 days, and 1-yr postoperatively. Information on PROs, including quality of life, return to work, pain, functional status, medical complications, and cognition, was obtained from online, mail, or telephone surveys. Results Using structured query language, 44,081 patients were identified in the electronic medical records as having visited the Center for Preoperative Assessment and Planning for preoperative assessment between July 16, 2012, and June 15, 2014, and 20,719 patients (47%) consented to participate in SATISFY-SOS. Baseline characteristics and health status were similar between enrolled and not enrolled patients. The response rate for the 30-day survey was 62% (8% e-mail, 73% mail, and 19% telephone) and for the 1-yr survey was 71% (13% e-mail, 78% mail, and 8% telephone). Conclusions SATISFY-SOS demonstrates the feasibility of establishing a PRO registry reflective of a busy preoperative assessment center population, without disrupting clinical workflow. Our experience suggests that patient engagement, including informed consent and multiple survey modalities, enhances PROs collection from a large cohort of unselected surgical patients. Initiatives like SATISFY-SOS could promote quality improvement, enable efficient perioperative research, and facilitate outcomes that matter to surgical patients.

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Patient Reported Outcomes (PROs) – a Tool for Strengthening Patient Involvement and Measuring Outcome in Orthopaedic Outpatient Rehabilitation

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1241-4897 ◽

2020 ◽

Author(s):

Marcus Müller ◽

Joscha Brunssen ◽

Martin Messingschlager

Keyword(s):

Lower Extremity ◽

Patient Reported Outcomes ◽

Patient Involvement ◽

Pain Treatment ◽

Cervical Disc ◽

Outpatient Rehabilitation ◽

Positive Effects ◽

Disc Surgery ◽

Patient Reported ◽

Quick Dash

AbstractThe present study serves to establish Patient Reported Outcomes (PROs) as a tool for strengthening patient involvement and measuring outcomes in orthopaedic outpatient rehabilitation. Assessments by FFbH-R (Hannover Back Function Questionnaire for patients with back problems), Quick-DASH (Disabilities of Arm, Shoulder, and Hand Score for patients with upper extremity lesions), and LEFS (Lower Extremity Function Scale for patients with lower extremity lesions) were employed in 20 outpatient rehabilitation centres over a period of 12 months to evaluate changes in performance and participation from the subjective patient perspective. The following questionnaires were used: FFbH-R status post: lumbar disc surgery; cervical disc surgery; spinal canal decompression; conservative back pain treatment; other; Quick-DASH status post: rotator cuff reconstruction; shoulder arthroplasty; fracture (conservative or osteosynthesis); other; LEFS status post: hip arthroplasty; knee arthroplasty; anterior cruciate ligament repair; osteotomy; fracture (conservative treatment or osteosynthesis); other. Analysis of the 6,751 usable data sets demonstrated significant positive changes in all scores and diagnostic subgroups. The mean difference in score was 14.2 points in the FFbH-R, − 22 points in the Quick-DASH and 18 points in the LEFS. Thus, this study proves the positive effects of orthopaedic rehabilitation in an outpatient setting. PROs were instituted on a permanent basis in seven of the participating institutions.

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Utility of a Mobile Clinical Decision Support Application in Patients Undergoing Spinal Cord Stimulation.

Neurosurgery ◽

10.1093/neuros/nyz310_358 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Shervin Rahimpour ◽

Sarah E Hodges ◽

Luis A Antezana ◽

Abena A Ansah-Yeboah ◽

Rajeev Dharmapurikar ◽

...

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Decision Support ◽

Patient Reported Outcomes ◽

Clinical Decision ◽

Software Platform ◽

Clinical Specialist ◽

Mobile Software ◽

Patient Reported

Abstract INTRODUCTION Novel technologies to support real-time patient education, engagement and scalable outcomes monitoring to make clinically meaningful decisions are needed. The ManageMySurgery (MMS) Spinal Cord Stimulation (SCS) module is a mobile clinical decision support application that provides: (1) a mobile, patient-centered engagement tool for delivering pre-, peri- and postoperative SCS information; (2) scalable patient-reported outcomes collection; (3) a HIPAA-compliant 2-way messaging platform with a Clinical Specialist Educator for real-time support and goal setting. METHODS Prospective data was collected using the MMS mobile smartphone application in patients undergoing Medtronic SCS trial and permanent implant procedures. E-consent was obtained through the HIPAA compliant, mobile software platform. All data was de-identified, aggregated and analyzed. RESULTS A total of 20 patients (15-trial SCS and 5 permanent SCS patients) agreed to participate and logged onto the mobile software platform. For trial SCS patients, 100% of those that participated experienced >50% pain relief as documented in their patient-reported outcomes. Furthermore, patients found various features of the software platform helpful for navigating different aspects of their SCS procedure, with 81% finding MMS helpful in preparing for their SCS procedure, 88% finding MMS helpful in recovering from their SCS procedure and 94% in communicating with their Clinical Specialist Educator. In addition, 95% of patients would recommend MMS to a friend or family member. CONCLUSION The MMS platform appears to have utility both during the SCS Trial and Permanent procedures. In patients with chronic pain, novel patient engagement and follow-up tools such as MMS may be a good option for keeping patients engaged with the therapy and ensuring patients stay on track during their procedural journey. Randomized, controlled trials with extended follow-up are in progress and needed to further evaluate the utility of MMS in patients with chronic pain undergoing SCS.

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Microcannula Utilization for Injectable Facial Fillers: Standard of Care?

The American Journal of Cosmetic Surgery ◽

10.1177/0748806818781633 ◽

2018 ◽

Vol 35 (4) ◽

pp. 189-197 ◽

Cited By ~ 1

Author(s):

Kian Karimi ◽

Chester F. Griffiths ◽

Alex Reivitis ◽

Austin Davis-Hunter ◽

Elizabeth Zhang ◽

...

Keyword(s):

Adverse Events ◽

Electronic Medical Records ◽

Medical Records ◽

Standard Of Care ◽

Dermal Filler ◽

Popular Method ◽

Patient Reported ◽

Clinical Series ◽

Filler Injections

The microcannula technique has become an increasingly popular method for injecting cosmetic fillers. Previous studies have illustrated that the microcannula technique allows filler to be injected with less pain, swelling, and essentially no bruising. This study is a retrospective clinical series examining 247 patients who have undergone dermal filler injections using the microcannula technique from 2011 to 2016 with a single injector, Kian Karimi. The purpose of this study is to assess the frequency of adverse events associated with injections such as bruising and swelling. All 666 recorded patient visits from 2011 to 2016 were analyzed using electronic medical records based on the criteria that the patients had cosmetic filler using the microcannula technique by the surgeon investigator. Of the 666 filler treatments using the microcannula technique, 3 treatments (0.5%) produced adverse events on the day of service, and 32 treatments (4.8%) produced adverse events at 2-week follow-up. In total, 5.4% of treatments produced adverse events. At the 2-week follow-up, 5.7% of treatments using the 25-gauge microcannula produced adverse events ( P = .830); 3.9% of treatments using the 27-gauge microcannula produced adverse events ( P = .612]). Only 3 patients were treated with the 30-gauge microcannula, and 1 patient reported adverse events on the day of service. None of the treatments using the 30-gauge microcannula produced adverse events at the 2-week follow-up ( P = .160). The data support that the microcannula technique is a safe and effective alternative to hypodermic needles for the injection of dermal filler to minimize common adverse events.

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Predicting chronic pain after major traumatic injury

Scandinavian Journal of Pain ◽

10.1515/sjpain-2019-0040 ◽

2019 ◽

Vol 19 (3) ◽

pp. 453-464 ◽

Cited By ~ 1

Author(s):

Elisabeth B. Powelson ◽

Brianna Mills ◽

William Henderson-Drager ◽

Millie Boyd ◽

Monica S. Vavilala ◽

...

Keyword(s):

Chronic Pain ◽

Electronic Medical Records ◽

Medical Records ◽

Traumatic Injury ◽

Opioid Use ◽

Post Injury ◽

Regional Analgesia ◽

Final Model ◽

Opioid Medications

Abstract Background and aims Chronic pain after traumatic injury and surgery is highly prevalent, and associated with substantial psychosocial co-morbidities and prolonged opioid use. It is currently unclear whether predicting chronic post-injury pain is possible. If so, it is unclear if predicting chronic post-injury pain requires a comprehensive set of variables or can be achieved only with data available from the electronic medical records. In this prospective study, we examined models to predict pain at the site of injury 3–6 months after hospital discharge among adult patients after major traumatic injury requiring surgery. Two models were developed: one with a comprehensive set of predictors and one based only on variables available in the electronic medical records. Methods We examined pre-injury and post-injury clinical variables, and clinical management of pain. Patients were interviewed to assess chronic pain, defined as the presence of pain at the site of injury. Prediction models were developed using forward stepwise regression, using follow-up surveys at 3–6 months. Potential predictors identified a priori were: age; sex; presence of pre-existing chronic pain; intensity of post-operative pain at 6 h; in-hospital opioid consumption; injury severity score (ISS); location of trauma, defined as body region; use of regional analgesia intra- and/or post-operatively; pre-trauma PROMIS Depression, Physical Function, and Anxiety scores; in-hospital Widespread Pain Index and Symptom Severity Score; and number of post-operative non-opioid medications. After the final model was developed, a reduced model, based only on variables available in the electronic medical record was run to understand the “value add” of variables taken from study-specific instruments. Results Of 173 patients who completed the baseline interview, 112 completed the follow-up within 3–6 months. The prevalence of chronic pain was 66%. Opioid use increased from 16% pre-injury to 28% at 3–6 months. The final model included six variables, from an initial set of 24 potential predictors. The apparent area under the ROC curve (AUROC) of 0.78 for predicting pain 3–6 months was optimism-corrected to 0.73. The reduced final model, using only data available from the electronic health records, included post-surgical pain score at 6 h, presence of a head injury, use of regional analgesia, and the number of post-operative non-opioid medications used for pain relief. This reduced model had an apparent AUROC of 0.76, optimism-corrected to 0.72. Conclusions Pain 3–6 months after trauma and surgery is highly prevalent and associated with an increase in opioid use. Chronic pain at the site of injury at 3–6 months after trauma and surgery may be predicted during hospitalization by using routinely collected clinical data. Implications If our model is validated in other populations, it would provide a tool that can be easily implemented by any provider with access to medical records. Patients at risk of developing chronic pain could be selected for studies on preventive strategies, thereby concentrating the interventions to patients who are most likely to transition to chronic pain.

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