Tracking outcomes

[PainstakingMD]

How do established pain physicians track their outcomes? I'm a current pain fellow with an interest in this topic as it will likely be a big component of our reimbursement in the future (tracking and reporting outcomes). I'm frustrated by the retrospective, biased, NRS 0-10 responses that we receive at point-of-care when seeing patients in clinic.

Do you track medicinal interventions differently than procedural interventions?

Do you have any systems within your clinic to facilitate this data collection?

Thanks for sharing your experiences.

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[ziggyziggy]

I am aware of one big multispeciality group who keeps a percentage of physician reimbursements and then pay it in proportion to patient satisfaction surveys. They include all kinds of patients in data collection.

 

[bedrock]

I am aware of one big multispeciality group who keeps a percentage of physician reimbursements and then pay it in proportion to patient satisfaction surveys. They include all kinds of patients in data collection.

That would never work for pain or ER as patients will give low ratings to the physicians that follow proper medical standards and don't hand out opiates like candy whenever the patients demand them.

I'd cut off my nuts before working for a group like that..... or maybe that's a requirement before joining.............

 

[loveoforganic]

How do established pain physicians track their outcomes? I'm a current pain fellow with an interest in this topic as it will likely be a big component of our reimbursement in the future (tracking and reporting outcomes). I'm frustrated by the retrospective, biased, NRS 0-10 responses that we receive at point-of-care when seeing patients in clinic.

Do you track medicinal interventions differently than procedural interventions?

Do you have any systems within your clinic to facilitate this data collection?

Thanks for sharing your experiences.

How about an established ease of completing tasks of daily living questionnaire? Seems like it would offer more reliability than something like perception of pain

 

[powermd]

How do established pain physicians track their outcomes? I'm a current pain fellow with an interest in this topic as it will likely be a big component of our reimbursement in the future (tracking and reporting outcomes). I'm frustrated by the retrospective, biased, NRS 0-10 responses that we receive at point-of-care when seeing patients in clinic.

Do you track medicinal interventions differently than procedural interventions?

Do you have any systems within your clinic to facilitate this data collection?

Thanks for sharing your experiences.

On my follow up forms patients who had a recent procedure rate their pain and functional benefits in % terms, and the duration of the benefit. It's rough and highly subjective, but it's also quick and minimally burdensome on the patient. A full page functional questionnaire wouldn't fly here!

One local hospital where my group has privileges requires us to do at least one QA assessment per year. This past year we did a survey of our kyphoplasty patients asking them at 1 month out the following:
Is your pain at least 50% improved from the time just prior to the procedure?
Can you do the activities you used to do before the fracture?
Are you satisfied with the procedure?

N=45, and we had about 80-90% overall satisfaction.

I'm not sure what our next one will be. I'd like to do SI RF, but it would be tough to get adequate numbers for meaningful data.

 

[Gauss]

I am aware of one big multispeciality group who keeps a percentage of physician reimbursements and then pay it in proportion to patient satisfaction surveys. They include all kinds of patients in data collection.

ahem!
previous, and somewhat neglected post of mine: http://forums.studentdoctor.net/showthread.php?t=889546

The Cost of Satisfaction
A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality

http://archinte.ama-assn.org/cgi/con...nmed.2011.1662

ABSTRACT

Background Patient satisfaction is a widely used health care quality metric. However, the relationship between patient satisfaction and health care utilization, expenditures, and outcomes remains ill defined.
Methods We conducted a prospective cohort study of adult respondents (N = 51 946) to the 2000 through 2007 national Medical Expenditure Panel Survey, including 2 years of panel data for each patient and mortality follow-up data through December 31, 2006, for the 2000 through 2005 subsample (n = 36 428). Year 1 patient satisfaction was assessed using 5 items from the Consumer Assessment of Health Plans Survey. We estimated the adjusted associations between year 1 patient satisfaction and year 2 health care utilization (any emergency department visits and any inpatient admissions), year 2 health care expenditures (total and for prescription drugs), and mortality during a mean follow-up duration of 3.9 years.

Results Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).

Conclusion In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.

 

[PainstakingMD]

IMMPACT recs from large survey among chronic pain patients published in Pain 137 (2008) 276–285:
"In addition to pain reduction, the most important aspects were enjoyment of life, emotional well-being, fatigue, weakness, and sleep-related problems. Chronic pain clearly impacts health-related quality of life. The results of the two phases of the study indicate that people with chronic pain consider functioning and well-being as important areas affected by the presence of symptoms and as appropriate targets of treatment. These multiple outcomes should be considered when evaluating the efficacy and effectiveness of chronic pain treatments.

Powermd, It seems that you have a good system in place. I think a standardized follow up form gives more reliable data than asking the patient on the spot. The main problem I have with these assessments at the point of care are the multiple biases involved when patients retrospectively recount how they did following an intervention (meds, PT, psych, procedure, etc.). In our clinic, the nurses often ask leading questions such as, "how much was your pain affected by________?... 30%, 50%, 80% relief?" They invariably choose one of these options. It is perhaps more frustrating to try to tease out duration of changes in pain and function following interventions.

As smart technology becomes more pervasive in the U.S., I'm sure that various "Apps" will be developed that will allow us track our interventions prospectively. While not everyone will have the means to be able to use this technology, it would likely be helpful for those who can.

 

[loveoforganic]

"how much was your pain affected by________?... 30%, 50%, 80%

You could use a visual analogue scale and instruct them that the left side is 0 relief, the right side is complete relief, and to mark where they feel currently.

 

[Ducttape]

Have the parient fill out an Oswestry Disability form each time they check in for an appointment.

My current questionairre is simpler and unfortunately currently directed specifically at insurance company denials.

Finally working in a hospital based clinic, we are exposed to their whims and methods of assessments.

 

[jesspt]

What about regionally specific outcome questionaires such as the Oswestry for low back, the neck disaiblity index for neck pain, the lower extremity functional scale for LE symptoms, the shoulder pain and disability index, etc.?

Also the Patient Specific Functional Scale is gaining favor in rehabilitation, and it could be taken upon intake by nurse/ MA, etc.

http://www.tac.vic.gov.au/upload/Patient-specific.pdf

 

[joshmir]

would you mind posting your modified questionnaire? did the insurance company provide you with the modified questionnaire? did your office modify it? are the modifications validated?

thanks