At the American Pain Society (APS) meeting, a number of posters highlighted research conducted at Stanford University, in the laboratory of Sean Mackey, MD, PhD. The first article in our series on the National Pain Strategy (NPS)1 outlined the focus areas and directions of this plan, designed in an endeavor to improve pain care, pain management, but also pain research and education.
In this and following articles, we will cover work presented at the conference, highlighting successful implementation of the NPS which resulted in improvements in pain research and pain management. One such example was presented by Dr Mackey at the APS conference earlier this month: the cross-disciplinary lower back pain program which he spearheads at Stanford Pain Management Center. By translating the NPS to an academic setting, this program led to significant improvements in patient pain management.
The Stanford Pain Management Center2 provides a comprehensive referral pain center: it receives about 20000 patient visits per year in the clinic, and hosts 21 physicians and faculty (all of whom are trained in pain medicine), 5 pain psychology faculty, and a wide array of integrative care, including physical therapy, acupuncture, and nutrition biofeedback. But what Dr Mackey deems to be vital to the success of the Center, is that its members stay up-to-date with ongoing research in the area of pain.
While other pain centers tend to function as ‘silos of excellence’ in the words of Dr Mackey, the Stanford Pain Management Center hosts all of the pain-related programs, allowing for effective pain management. This essential element for a streamlined pain care, and which consists in bringing together all relevant departments, prompted Dr Mackey to offer centers around the country still operating in silos, the necessary infrastructure and funding, in order to allow them to transition to a more collaborative model. These changes have proven incredibly successful, affirms Mackey.
In close collaboration with primary care physicians, Dr Mackey and his colleagues also built a ‘networked chronic pain program’, initially focusing on self-care and self-management approaches. Their goal with this program was to ‘embed’ pain physicians into primary care practices, both within Stanford and at satellite systems throughout the Bay area. Another initiative which sprung from this plan, integrates back-to-school programs as well as secondary consultations with mental health providers, for an inter-disciplinary model of chronic pain care.
The Silicon Valley culture in which Stanford is deeply rooted has contributed to the heavily data-driven approach adopted by the program, according to Dr Mackey: data gathered at all stages of the pain management process is used to inform treatment services. And this was one of the requirements of both the NPS and the initial Institute of Medicine (IOM) report3.
In a separate 12 part series from the IOM4, Mackey and his colleagues called to develop and implement the healthcare system through science, informatics, incentives, cultural alignment and continuous improvements in innovation through research and discovery.
A shift to patient-related outcomes and a goal to achieve the best outcomes possible at the lowest cost are vital, according to Dr Mackey. “There is a need for a patient-centered system organized around the patient’s needs”, he declared. Unfortunately, very few such platforms are in place, and data quality from patients’ electronic medical records was, in Dr Mackey’s words, ‘atrocious’. This prompted him and his team to create an open source learning healthcare platform, the ‘Collaborative Health Outcomes Information Registry’ (CHOIR)5, a free tool designed to help gather information needed in ‘real world patients’.
CHOIR provides a point of care decision-making for longitudinal research, a software-based decision-making tool to monitor patient experience, as well as data which may be used in clinical trials. It also allows physicians to establish a comprehensive phenotypic assessment of patients across all dimensions (physical, psychological and social functioning). Multiple clinics at Stanford and in collaborating institutions have already integrated this tool into their sites and are working closely together.
The last step, according to Mackey was to extend these programs to include patients’ experience and satisfaction, factors that are critical to patient care. The Stanford Center therefore built a patient experience program, which was termed ‘System to Enhance Patients Experience’ (STEPx)6, in an effort to both control and understand available data. STEPx was designed to capture data covering all points of the patient care experience, with the goal of developing research-quality data, allowing the Center to reach its goals.
Our next NPS feature article will highlight how the tools designed at Stanford’s Pain Management Center presented here were successfully used to improve chronic lower back pain management.
1.The National Pain Strategy: https://iprcc.nih.gov/docs/drafthhsnationalpainstrategy.pdf
2.The Stanford Pain Management Center: https://stanfordhealthcare.org/medical-clinics/pain-management.html
3. The Institute of Medicine report: https://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Pain%20Research%202011%20Report%20Brief.pdf
4. Rehabilitation Approaches and Issues in Chronic Pain: http://www.nap.edu/read/991/chapter/14#233
5. The Collaborative Health Outcomes Information Registry: https://choir.stanford.edu/
6. The System to Enhance Patience Experience: http://snapl.stanford.edu/stepx/