Original Article

Journal of General Internal Medicine

, Volume 25, Issue 9, pp 900-905

Open Access This content is freely available online to anyone, anywhere at any time.

Does Screening for Pain Correspond to High Quality Care for Veterans?

  • Lisa ZubkoffAffiliated withDepartment of Veterans Affairs Greater Los Angeles Healthcare SystemNew England Health Care Engineering Partnership Email author 
  • , Karl A. LorenzAffiliated withDepartment of Veterans Affairs Greater Los Angeles Healthcare SystemRAND CorporationDavid Geffen School of Medicine, UCLA
  • , Andy B. LantoAffiliated withDepartment of Veterans Affairs Greater Los Angeles Healthcare System
  • , Cathy D. SherbourneAffiliated withRAND Corporation
  • , Joy R. GoebelAffiliated withDepartment of Nursing, California State University School of Nursing
  • , Peter A. GlassmanAffiliated withDepartment of Veterans Affairs Greater Los Angeles Healthcare SystemRAND CorporationDavid Geffen School of Medicine, UCLA
  • , Lisa R. ShugarmanAffiliated withRAND Corporation
  • , Lisa S. MeredithAffiliated withRAND Corporation
  • , Steven M. AschAffiliated withDepartment of Veterans Affairs Greater Los Angeles Healthcare SystemRAND CorporationDavid Geffen School of Medicine, UCLA

Abstract

BACKGROUND

Routine numeric screening for pain is widely recommended, but its association with overall quality of pain care is unclear.

OBJECTIVE

To assess adherence to measures of pain management quality and identify associated patient and provider factors.

DESIGN

A cross-sectional visit-based study.

PARTICIPANTS

One hundred and forty adult VA outpatient primary care clinic patients reporting a numeric rating scale (NRS) of moderate to severe pain (four or more on a zero to ten scale). Seventy-seven providers completed a baseline survey regarding general pain management attitudes and a post-visit survey regarding management of 112 participating patients.

MEASUREMENT AND MAIN RESULTS

We used chart review to determine adherence to four validated process quality indicators (QIs) including noting pain presence, pain character, and pain control, and intensifying pharmacological intervention. The average NRS was 6.7. Seventy-three percent of charts noted the presence of pain, 13.9% the character, 23.6% the degree of control, and 15.3% increased pain medication prescription. Charts were more likely to include documentation of pain presence if providers agreed that “patients want me to ask about pain” and “pain can have negative consequences on patient’s functioning”. Charts were more likely to document character of pain if providers agreed that “patients are able to rate their pain”. Patients with musculoskeletal pain were less likely to have chart documentation of character of pain.

CONCLUSIONS

Despite routine pain screening in VA, providers seldom documented elements considered important to evaluation and treatment of pain. Improving pain care may require attention to all aspects of pain management, not just screening.

KEY WORDS

pain quality assessment veterans