National Pain Data Bank Minimizes Professional Risk
The American Academy of Pain Management created the National Pain Data Bank (NPDB) outcomes measurement instrument in the early 90’s — before national policy makers began to insist on the use of standardized outcomes measurement systems in health care. The Academy positioned itself to provide practitioners with a uniform method of documenting important parameters in the treatment of chronic pain patients. Treatment programs across the country began using this system to compare themselves to similar programs in terms of patient outcome and quality of service delivery. By the end of 2002, the NPDB had enrolled more than 100 pain management programs and had over 13,000 patients in the data bank. The NPDB provides comparison benchmarks for successful treatment outcomes for both solo practitioners as well as large multi-disciplinary treatment programs. The NPDB is an important tool for helping pain management programs comply with pain outcomes measurement standards imposed by national accrediting agencies.
In addition to providing needed outcomes measures, the Academy recognizes the inherent risks to professionals who use opioid therapy with their pain patients. The recent oxycodone abuse controversy demonstrates that prescribers would benefit from having a convenient way to ensure adequate documenting of opioid treatment parameters and outcomes (see article by Dr. Cole in this issue). In response to this need, an additional software module will be made available as a part of the NPDB Short Form electronic version to provide a simple, consistent approach to recording and archiving information that will aid the physician in demonstrating responsible and appropriate opiate prescribing practices. Based on Dr. Cole’s article entitled “Prescribing Opioids, Relieving Patient Suffering and Staying Out of Personal Trouble With Regulators” (The Pain Practitioner, Vol. 12, No. 3, Fall 2002) the software will prompt the physician to collect important patient information at the first encounter, including screening for substance abuse and/or psychological dependency. Prompts will also help the physician to document prescribing and pharmacy exclusivity agreements and second opinion/consultations in addition to typical patient information. The software will also assist the treatment provider in collecting basic information at each encounter in addition to documenting attempts at reducing dosage and obtaining urine screens on a regular basis, if necessary.
The National Pain Data Bank measurement system is comprised of three separate questionnaires that patients complete at intake, discharge and follow-up. In addition to sub-scale and total scores, a narrative report can be generated at intake that gives a summary description of the patient’s pattern of responding to crucial dimensions of the pain experience including pain intensity, functional status and emotional health. These are the three domains recognized as crucial in determining outcome by the International Association for the Study of Pain (IASP).
With the help of Applied Measurement Professionals, the University of California at San Diego and the Department of Veterans Affairs, several reliability and validity studies were undertaken that demonstrated adequate psychometric properties of select sub-scales of the NPDB questionnaires. In an effort to enhance the clinical utility and efficiency of the Academy’s outcomes measures and to make them more useful for documenting treatment progress, AAPM, in cooperation with the Department of Veterans Affairs James Haley Hospital in Tampa, Florida, created a short version of the NPDB. This NPDB Short Form consists of 17 items drawn from the original instrument that—for the most part—demonstrated the strongest reliability and validity in assessing pain and patient status. The Short Form provides scales for measuring a patient’s perception of pain and the impact of pain on mobility, vitality, activities of daily living, emotional well-being, ability to travel and fear of increasing activity. A paper and pencil version of the NPDB Short Form is available from AAPM. The questionnaire can be given at each patient visit and kept in the patient’s chart. A scoring form provides the clinician with a method to quickly generate sub-scale scores and a total impairment score. These scores can then be transferred to a cumulative scoring record for plotting of pain intensity and impact of pain on functioning across patient visits.
Currently, software is being developed for the practitioner’s use that can take patient responses gathered at each treatment session and produce graphical depictions of pain and functional status. Graphs can also be produced that track improvement over the course of treatment. These may be printed for inclusion in the patient’s chart, and saved to disk for use in word-processed documents such as treatment summaries. While the selection of items for the revised electronic version of the Short Form has not yet been finalized, the software system for administration is already available in a beta testing version.