Helping Pain Clinics Use Surveys to Understand Patient-Centered Factors That Affect Treatment

This PCORI-funded implementation project made surveys of patient-centered factors part of regular care for patients at pain clinics.

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.

Stakeholders Involved in This Project

• University of Pittsburgh School of Medicine Chronic Pain Research Program and the Center for Innovation in Pain Care (CIPC)
• Patient and stakeholder advisors including an occupational therapist, a physician with expertise in chronic pain, patients with chronic pain, and a representative from the American Chronic Pain Association

Publicly Accessible Project Materials

• Clinician training and demonstration videos
• Further information and training materials are available upon request at: https://www.paininnovation.pitt.edu/ and https://www.HEALingFactors.pitt.edu
• The HEAL surveys about Treatment Expectancy, Positive Outlook, Spirituality, and Attitudes toward Complementary and Alternative Medicine (CAM) will be available without charge as of April 2023. 

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.

Project Achievements

• Demonstrated the feasibility of implementing HEAL in chronic pain settings
• Programmed HEAL into the Collaborative Health Outcomes Information Registry (CHOIR), an electronic platform that allows patients to complete surveys about their health
• Created education materials to facilitate the use of HEAL
• Trained 74 clinic staff in using HEAL
• Reached 23,475 patients with chronic pain who were seeking and receiving treatment at 7 University of Pittsburgh Medical Center Pain Medicine clinical sites
• Successfully implemented strategies to maximize uptake of HEAL/CHOIR during telemedicine visits in response to the COVID-19 pandemic

Implementation Strategies

• Used a clinical decision support tool
• Adapted HEAL based on patients’ and clinics’ preferences and to work with sites’ existing resources and workflows
• Incorporated HEAL into CHOIR and enabled the generation of completed reports for patients and clinicians
• Used data warehousing techniques
• Used a train-the-trainer approach
• Trained clinicians, through in-person meetings and online videos, to access, interpret, and use the HEAL reports during a clinic visit
• Trained front desk staff and medical assistants to support patients’ use of HEAL
• Provided tools to support implementation of HEAL, including clinician FAQs
• Provided clinic-specific audit and feedback reports
• Identified and prepared champions at each site
• Provided educational materials to patients, including FAQ sheets
• Provided technical assistance to sites, including ongoing consultation and practice facilitation

Evaluation Measures

To document implementation:

• Number of unique patients eligible to complete HEAL
• Number of surveys completed during the project
• Patient survey completion rate (number of surveys completed relative to the number of appointments for which a survey was requested)
• Number of views of clinician PDF reports of patient surveys
• Number of clinic staff trained

To assess healthcare and health outcomes:

• Non-opioid pain management and reduced use of strong opioids
• Referrals to nonpharmacologic treatment approaches such as psychology, physical therapy, or occupational therapy
• Healthcare utilization

• PROMIS outcomes: pain intensity, pain interference, physical function, depression, anxiety

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%).