This implementation project is complete.
PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.
This PCORI-funded implementation project made surveys of patient-centered factors part of regular care for patients at pain clinics.
|Chronic pain, which may last for months or even years, can disturb people’s daily lives and their relationships with others. Patient-centered factors, such as patient beliefs and expectations about their pain and how treatments work, can affect how they respond to treatment. Measuring these factors and addressing them in clinic visits can help improve patients’ health.|
What was the goal of this implementation project?
Healing Encounters and Attitudes Lists, or HEAL, is a set of surveys that measure patient expectations about treatment. They also measure patients’ outlook on life and their connections with their doctors and nurses. HEAL offers doctors and patients a way to understand and talk about patient beliefs and expectations. They can use this information to choose treatments that work well for each patient. A PCORI-funded study used HEAL and found that patients with chronic pain who had higher HEAL scores reported greater symptom improvement after two and four months of treatment than patients with lower HEAL scores.
This project worked to make HEAL part of regular care at seven pain clinics in one health system to improve care for patients seeking treatment for chronic pain.
What did this project do?
The project team successfully put HEAL in place at seven pain clinics that are part of the University of Pittsburgh Medical Center. Clinics were in urban, suburban, and rural areas. They used HEAL and another survey called CHOIR to learn how pain affects patients’ lives. They also used the surveys to learn how patients view their treatments.
Patients filled out the surveys at the clinic or at home. Clinicians could view a report with patients’ responses in patients’ charts. Clinicians were doctors, nurse practitioners, physician assistants, or psychologists. Patients and clinicians could then discuss the results during visits.
To make HEAL part of care at pain clinics, the project team:
- Talked with patients and staff at pain clinics to understand how they could use HEAL to plan treatment
- Programmed HEAL to be part of the online survey that clinics already used
- Created a set of training materials
- Trained 74 pain clinic staff at lunch and learns, staff retreats, and at video trainings on how to use HEAL as part of patient care
- Identified a champion at each clinic to promote the use of HEAL
- Provided regular feedback reports to clinics about patient and clinician use of HEAL
- Provided ongoing support to clinics in using HEAL
What was the impact of this project?
During the project, 23,475 patients with chronic pain completed more than 58,000 surveys. Of patients who had a clinic visit, 80% had completed HEAL. Clinicians viewed 49,772 reports, or 86% of patients’ completed surveys. Before the project, clinicians viewed 76% of completed surveys.
The project team’s evaluation showed that, over 27 months:
- The number of patients prescribed strong opioids (Schedule II) decreased from 2,313 to 1,719. This number represented a decrease from 28% to 21% of all prescriptions ordered for these patients.
- Among patients who had a clinic visit after completing HEAL, referrals for injections decreased from 39% of patients to 27%.
- Counter to expectations, referrals for mental health services decreased from 17% to 9%. Also, referrals for physical or occupational therapy decreased from 23% to 19%.
- Referrals to integrative medicine increased from 0.8% to 2%. But the number of referrals was low compared with other types of referrals.
- Use of emergency care did not change.
- After adding HEAL at the clinics, patient-reported outcomes related to pain, function, depression, sleep, and anxiety showed greater improvements compared with outcomes before adding HEAL.
All clinics will continue to use HEAL. The health system is also expanding the use of HEAL to other clinics. Future sites can use the training materials and consult with a clinic administrator to put HEAL in place. The project team has made the training materials publicly available upon request.
Cost of Implementation:
This Project Team examined the costs associated with making the HEAL surveys a part of regular patient care at seven UPMC pain clinics.
The largest cost was for staff time to program the HEAL questions into the CHOIR survey. Other costs were for site preparations during the pre-implementation phase, as well as training staff to deliver and use the HEAL questions.
For more details, view this project’s Cost of Implementation Report, which will be posted here when available.PCORI supplemental funding supported project activities to capture and analyze the costs of implementation during this project. PCORI’s goal is to provide decision-makers at future sites with information they can use when considering adoption of the intervention that was the focus of this PCORI-funded implementation project.
More about this implementation project:
Stakeholders Involved in This Project
Publicly Accessible Project Materials
For more information about these materials, please contact the Project Team leader at [email protected].
The project team developed these materials, which may be available for free or require a fee to access. Please note that the materials do not necessarily represent the views of PCORI and that PCORI cannot guarantee their accuracy or reliability.
To document implementation:
To assess healthcare and health outcomes:
COVID-19-Related Project Activities
PCORI supplemental funding supported project activities to address evolving or emerging needs in the context of the COVID-19 public health crisis.
To reduce the risk of spreading the COVID-19 virus, many health systems shifted from in-person care to telehealth. Telehealth is a way to provide care to patients remotely using phone, video, or monitoring devices that can help manage care.
With the enhancement, the project team developed supports in using HEAL for patients with chronic pain during telehealth visits, including training for clinicians. Patients filled out the survey at home instead of in the waiting room. The team found that clinics continued to use HEAL during the pandemic. The patient survey completion rate was high (83%), and clinician views of the reports were also high (96%).
Related Journal Citations
Study Registration Information
Initial PCORI-funded Research Study
This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Using Surveys to Assess Patient-Centered Factors that May Affect Responses to Chronic Pain Treatment