Computer-Administered Patient Reported Outcomes (PRO) and Psychiatric Screening in Outpatient Pain Patients: Effect of a Point-of-Care Biopsychosocial Patient Health Report on Treatment Outcomes

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Title: Computer-Administered Patient Reported Outcomes (PRO) and Psychiatric Screening in Outpatient Pain Patients: Effect of a Point-of-Care Biopsychosocial Patient Health Report on Treatment Outcomes
Author: Swanholm, Eric Neal
Abstract: Rationale : Chronic pain is a widespread health problem that carries steep costs for both individuals and society . Pain -related complaints represent one of the most common presenting symptoms across ambulatory care settings . Individuals with chronic pain often have comorbid psychiatric symptoms and /or psychosocial dysfunction . Given the related impact on treatment and health -care costs , tracking psychiatric and psychosocial outcomes is beneficial for chronic pain patients , their health care providers , and service providers . Outcome -tracking interventions that could positively affect treatment outcomes hold potential benefits for patient care . Purpose : The purpose of the present study was to examine the effects of the regular collection and results feedback prior to the point -of -care on multiple patient -reported outcome (PRO ) domains in outpatient pain patients . Maximizing ecological validity and non -disruption of clinic flow were given significant focus in the study design and process . Patients and Methods : This study used repeated measures and was conducted in an outpatient pain management and interdisciplinary treatment clinic (2 anesthesiologists , 1 psychiatrist , 1 psychologist , 1 counselor , 1 physical therapist ) . A total of 69 pain patients were randomly assigned to one of two protocol -based PRO feedback intervention groups (separate feedback to both patients and providers [Dual Feedback] ; Provider -Only Feedback ) or a non -intervention group (Chart -Review Only ) . Assessments were completed prior to the point -of -care ; feedback for intervention groups was based upon a real -time , automated report generated from their PRO data . Data were gathered on touch -screen tablet -pc’s using multiple computer -adaptive -tests from the NIH -sponsored Patient Reported Outcomes Measurement Information Systems (PROMIS ) Assessment Center platform ; outcome domains included pain -related functioning (Pain Disability Questionnaire [PDQ] ; VAS pain rating ; PROMIS Physical Functioning , Pain Behavior , and Pain Interference ) , psychological symptoms and psychosocial variables (PROMIS Depression , Anxiety , Sleep -Related Impairment , Fatigue , Social Functioning ; hypomania history screen ; Pain Medication Questionnaire [PMQ ; opioid misuse risk] ) , global HRQoL (PROMIS Mental and Physical Health domains ) , treatment alliance (Working Alliance Inventory [WAI] ; ratings from both patients and providers] ) , and illness perception and optimism (Brief Illness Perception Questionnaire [BIPQ] ; Life Orientation Test - Revised ) . Performance -based data (walking time , grip strength , range -of -motion /flexibility ) were collected by the physical therapist for study patients whose treatment included a PT component (e .g . interdisciplinary pain program , individual services ) . Significant covariates were identified and incorporated into the primary analyses . Primary outcomes were the individual measures within each outcome domain . Analyses utilized mixed -effects modeling with random coefficients and multiple regression in comparisons of all three study groups . Secondary analysis included tabulation of completion time and comparisons between a Combined Feedback group (both intervention groups ) and Chart -Review Only . Results : Significant covariates included treatment type , history of psychiatric diagnosis , and a biological family history of psychiatric diagnosis . Comparing Dual Feedback vs . Chart Review Only , patients in the Dual Feedback intervention had significantly better outcomes over time for a number of domain outcomes ; specifically , in pain -related functioning /symptoms (PDQ [P = .003] ; PROMIS Pain Interference [P = .023] ; VAS pain [P = .03] ) , psychological and psychosocial variables (PROMIS Anger [P = .001] ; PROMIS Anxiety [P = .012] ; PROMIS Depression [P = .029] ; PROMIS Sleep -Related Impairment [P = .001] ; PROMIS Social Functioning – Satisfaction with Discretionary Social Activities [P = .047] ) , PROMIS Global HrQOL (Mental Health [P = .021] ; Physical Health [P = .032] ) , treatment alliance (WAI – Bond [patient -rated][P = .046] ) , illness perceptions (BIPQ – Consequence [P = .017] ; BIPQ – Timeline [P = .011] ; BIPQ – Treatment Control [P = .029] ) , and one performance -based measure (Walk Time [P = .007] ) . Similarly , patients in the Provider -Only group had better outcomes over time for multiple outcome domains ; including , pain -related functioning /symptoms (PDQ [P = .033] ; PROMIS Pain Interference [P = .031] ; PROMIS Fatigue [P = .036] ; PROMIS Physical Functioning [P = .049] ) , psychological and psychosocial variables (PMQ [opioid misuse risk][P = .041] ) , treatment alliance (WAI – Bond [patient -rated][P = .076] ; WAI – Bond [provider -rated][P = .008] ) , illness perceptions (BIPQ – Timeline [P = .048] ; BIPQ – Personal Control [P = .027] ) , and one performance -based measure (Walk Time [P = .035] ) . Comparisons between patients in the Dual Feedback and Provider -Only Feedback groups were significant for a few domain outcomes . Compared to Provider -Only Feedback , Dual Feedback had better outcomes over time for multiple domain measures ; including , the PDQ (P = .085 ) , PROMIS Anger (P = .000 ) , PROMIS Anxiety (P = .018 ) , and BIPQ – Treatment Control (P = .015 ) . Conversely , the Provider -Only group had better outcome scores over time for PROMIS Global HrQOL (Mental Health (P = .032 ) ; Physical Health (P = .074 ) . Analyses of process variables showed a mean completion time of 15 .8 minutes for the entire assessment ; completion -time statistics were also calculated for the 11 PROMIS computer -adaptive -tests (M = 7 .57 minutes [all PROMIS CAT’s] ; M = 41 .3 second per measure , SD = 9 .3 seconds ) and other primary outcomes (PDQ , PMQ , BIPQ ) (M = 8 .23 minutes total ; M = 2 .74 minutes per measure , SD = .99 minutes ) . Conclusion : The provision of dual feedback (patient and providers ) from PRO data collected prior to the point -of -care had an impact on several outcomes from multiple domains (pain -related functioning , psychological symptoms , psychosocial variables , illness perception , walking performance ) over time , compared to patients who received no point -of -care feedback . To a lesser extent , group by time effects were also observed in comparisons between patients receiving provider -only feedback and those with no feedback . Brought together , high ecological validity was maintained with minimal disruption of clinic flow ; likely contributing factors include the use of a set framework for outcome -tracking , protocol -based delivery of feedback , and efficiency of administration . This is the first study to show the potential benefits of providing PRO data feedback to both patients and providers prior to the point -of -care . [Keywords : chronic pain , patient -reported outcomes , biopsychosocial , patient feedback , computer -adaptive -testing , point -of -care , treatment outcomes , PROMIS]
URI: http : / /hdl .handle .net /2152 .5 /1097
Date: 2012-08-13

Citation

Computer-Administered Patient Reported Outcomes (PRO) and Psychiatric Screening in Outpatient Pain Patients: Effect of a Point-of-Care Biopsychosocial Patient Health Report on Treatment Outcomes. Graduate School of Biomedical Sciences. Available electronically from http : / /hdl .handle .net /2152 .5 /1097 .

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