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14 Articles in Volume 18, Issue #7
A 2018 Update: The Federal Pain Research Strategy
A Commentary on Medical Cannabis
Are Abuse-Deterrent Opioids Appropriate for Your Pain Patient?
Behind the AHRQ Report
Challenges Facing Abuse-Deterrent Formulations
Demystifying Opioid Abuse-Deterrent Technologies
Editorial: Our Clinical Pain Neighborhood
Independent Pain Practice: A Case Example
Inside Performing Arts Medicine
Letters to the Editor: ACT Therapy; Compounded Topicals
Nerve Growth Factor and Targeting Chronic Pain
Pain Control for Athletes: What Works?
Quality Training: One Center’s Experience with Pain Assessment
The Importance of Developing Professional Relationships in Pain Practice

Quality Training: One Center’s Experience with Pain Assessment

JPS Health Network and the American Society of Clinical Oncology share their experience in improving pain documentation and plans of care.

The American Society of Clinical Oncology (ASCO) has been running a Quality Oncology Practice Initiative (QOPI) since 2002 to improve the quality of care for patients being treated for cancer. In addition to managing more than 180 quality measures, including pain management and end-of-life care measures, and launching a Qualified Clinical Data Registry in collaboration with the American Society for Radiation Oncology, ASCO runs a six-month Quality Training Program course that helps practices meet certain MIPS requirements. MIPS, or the Merit-Based Incentive Payment System, of the US Centers for Medicare and Medicaid Services (CMS), is based on performance in quality, resource use, clinical practice improvement activities, and use of certified electronic health record technology.

Clinical practices periodically self-report on a subset of measures to gauge their quality of care. By comparing their results to corresponding benchmarks, providers may then work to fill any gaps. In the Quality Training Program course, those practices that score high on 24 different measures and successfully pass an audit may receive special recognition via QOPI Certification, which may help them to meet MIPS requirements.1,2

JPS Health Network Center for Cancer Care, a tax-supported healthcare system providing services across Tarrant County, Texas, 
participated in the program during the 2016 QTP reporting period to focus on improving their plan of care documentation in pain management. While the center is cancer-based, its experience, findings, and new strategies have application to the non-cancer-related pain management setting. The JPS center provides services in medical and surgical oncology, hematology, palliative care, and more, with more than 33,000 patient visits completed in 2014 and 2015.

Specifically, JPS was looking to improve results from their Spring 2016 QOPI regarding a measure for “plan of care for moderate/severe pain documented.” JPS’s measure came in at 0% compared to the 70.94% QOPI average benchmark. “This area was prioritized as an improvement opportunity due in part to the frequently cited relationship between effective pain management and improved patient satisfaction and outcomes, as well as decreased ER and unscheduled clinic visits,” noted the JPS team in a presentation.3

The goal: to bring that measure up to 75% compliance, as measured by JPS’ Spring 2017 QOPI data submission one year later. JPS team members participating in the training included a medical director, medical oncologist, service line administrator, project director, nurse navigator, nurse lead, patient, and improvement coaches.

Figure 1 shows a JPS flow chart for a patient clinical encounter prior to the training and Figure 2 shows the problems identified during the training.3 In the summer of 2016, JPS introduced a pain scale survey for patients; 86% of patients who completed the survey reported experiencing moderate to severe pain. They also put into place a few interventions and strategies after the training – see Figure 3 and Table I for prioritized changes and results.3

Figure 1. Baseline process flow for patient clinic encounter (before training).3(Figure provided by author)

Figure 2. Cause-and-effect diagram(Figure provided by author)

Prioritized List of Changes(Figure provided by author)

Plan-Do-Study-Act (PDSA) Plan(Table provided by author)

Overall team conclusions were that:

  • sending feedback to providers regarding QOPI point-of-care measure for moderate to severe pain improved future documentation
  • enhanced visibility of pain score within provider note templates reminded the provider to include pain interventions in notes
  • retraining of medical assistants (M.A.s) underscored the importance of their role in asking patients for their current pain level and allowed them to see “bigger picture” of where their input impacts patient care.3


Below, JPS team representatives answer a few followup questions about their ASCO Quality Training Program experience.

Q. What was JPS’s original expectation when entering the program and what was most surprising once you started discussing your challenge in patient pain assessment?

A. It was our expectation to improve quality of care provided to our cancer patients through engagement with other practices and sharing of strategies and ideas in addition to expert instruction and support from ASCO. Most surprising was the lack of a standard pain assessment tool and/or documentation of pain management at the center.

Q. What were the JPS team’s major takeaways after the training program?

A. A practice needs to be very specific to what needs to be changed, ensure that it is a measurable change, and the smaller the project, the easier it is to test, change or implement, and accept into standard practice.

Q. Would you recommend the training program to other facilities and why?

A. Yes, there are a lot of good practice management strategies developed by others to easily implement in practice to improve quality of care, whether it be pain management or other improvement areas. In addition, the opportunity to make multidisciplined connections from not only all around the country but the globe with so many talented professionals in oncology is an invaluable resource to add to your quality improvement journey at your practice.

Q. Have you applied your findings/training to other aspects of pain care beyond the pain scale assessment and reporting changes?

A. Yes. We are more proactive in managing pain or referring to pain clinic due to implementation of pain scale on every chart and being able to acknowledge pain better and earlier.

Last updated on: October 4, 2018
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