Coordination of Care Matters Most to Patients With Chronic Pain

Nancy A. Melville

March 27, 2015

NATIONAL HARBOR, MD — When it comes to the satisfaction of patients with chronic pain, patient care coordination is what matters most — even more than the all-important patient-provider relationship that is often emphasized in patient satisfaction surveys, new findings suggest.

"We found that the main driver of the overall patient experience relies not as much on the individual provider, and much more so on the after-visit communication of plan and coordination of follow-ups," first author Ming-Chih Kao, MD, PhD, from the Stanford University's Pain Management Center, Redwood City, California, told Medscape Medical News.

Their findings were presented here at the American Academy of Pain Medicine (AAPM) 31st Annual Meeting.

Challenges With Patient Satisfaction

Pain medicine traditionally underperforms when it comes to patient satisfaction, the authors said, yet with this metric rising in the ranks as a key marker of healthcare quality, the pressure is on to step up and provide the highest levels of patient satisfaction possible.

To better understand the aspects of care that play the biggest role in driving that satisfaction, the Pain Management Center developed a platform/questionnaire called the System To Enhance Patient Experience (STEPx), which gauges patient experience with 20 items in several domains, including admission and check-in, outcomes, access and scheduling, physician and provider, care coordination, nursing and assistant, and one free-text item.

"[The STEPx] has enabled us to approach the question of patient experience with an open mind, using flexible Bayesian network methods that let the data speak for itself," Dr Kao said.

The survey was provided to 628 patients at the center at the postvisit over a 3-week period.

Among 139 patients who completed the questionnaire, satisfaction with care coordination had the strongest correlation with patient satisfaction, with 32% of variance in the analysis, followed by patient-facing staff and provider (22% of variance) and outcomes and provider (15%).

Likewise, outcomes were also most strongly associated with care coordination and had weaker correlations with other key domains.

For the study, care coordination specifically referred to "communications with the primary care physician, as well as having convenient appointment times that work well with the patient's own scheduling constraints," Dr Kao said.

The responses likely reflect the frustrations patients with chronic pain can face because of multiple medical comorbidities and disabilities that require complex care and often times no one physician assuming responsibility of the patient's overall care — or the "bystander effect," Dr Kao said.

"In pain medicine, patients typically have multiple specialists, making this issue of care coordination particularly salient."

The findings suggest that even patient satisfaction surveys may need retailoring in order to be asking the right questions, Dr Kao added.

"The individual provider is the main focus of patient satisfaction surveys, with the result that much quality improvement effort is narrowly focused on the 15-, 30-minute span of a provider visit."

"The individual provider remains important, but targeted interventions on care coordination may be much more effective in improving the overall patient experience."

On the basis of STEPx survey results, Stanford's Pain Management Center established two new positions for complex case care managers. These managers focus on accessibility and minimizing appointment wait time, with a goal of 1 week.

In addition to creating the new positions, the center has implemented "targeted efforts to reduce appointment wait times and repetitively communicating care plans to the patient with printers in each examination room," among other efforts, Dr Kao said.

And the efforts have already paid off, he noted.

"In short order, we have observed substantial and sustained improvements in our patient satisfaction."

Broad Implications

The study, and the pain center's actions, offer examples that have broad implications in an era of ever-increasing standards to improve chronic pain management, said James C. Watson, MD, a pain specialist and neurologist with the Mayo Clinic, Rochester, Minnesota, who moderated the session.

"[The study] is important because patient satisfaction is now being used as a marker of quality care and to inform on the level of reimbursement," he told Medscape Medical News.

"The Stanford group has looked at multiple domains in the patient care experience [and] collected data on which best correlated with patient satisfaction. Interestingly, it is patient care coordination more than provider interactions and outcomes."

The group's commitment of resources to patient care experience to improve patient satisfaction sets a notable example, he said.

"This is important as other health care organizations look to improve their patient satisfaction data and seek to identify where resources are best committed to this end."

The study received no outside funding. Dr Kao and Dr Watson have disclosed no relevant financial relationships.

American Academy of Pain Medicine (AAPM) 31st Annual Meeting. Abstract #191. Presented March 20, 2015.


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