Automating Collection of Pain-Related Patient-Reported Outcomes to Enhance Clinical Care and Research

  • Ashli Owen-Smith
  • Meghan Mayhew
  • Michael C. Leo
  • Alexandra Varga
  • Lindsay Benes
  • Allison Bonifay
  • Lynn DeBar
Original Research



Chronic pain is highly prevalent, and the ability to routinely measure patients’ pain and treatment response using validated patient-reported outcome (PRO) assessments is important to clinical care. Despite this recognition, systematic use in everyday clinical care is rare.


The aims of this study were to (1) describe infrastructure designed to automate PRO data collection, (2) compare study-enhanced PRO completion rates to those in clinical care, and (3) evaluate patient response rates by method of PRO administration and sociodemographic and/or clinical characteristics.


The Pain Program for Active Coping and Training (PPACT) is a pragmatic clinical trial conducted within three regions of the Kaiser Permanente health care system.

Program Description

PPACT evaluates the effect of integrative primary care-based pain management services on outcomes for chronic pain patients on long-term opioid treatment. We implemented a tiered process for quarterly assessment of PROs to supplement clinical collection and ensure adequate trial data using three methods: web-based personal health records (PHR), automated interactive voice response (IVR) calls, and live outreach.

Program Evaluation

Among a subset of PPACT participants examined (n = 632), the tiered study-enhanced PRO completion rates were higher than in clinical care: 96% completed ≥ 1 study-administered PRO with mean of 3.46 (SD = 0.85) vs. 74% completed in clinical care with a mean of 2.43 (SD = 2.08). Among all PPACT participants at 3 months (n = 831), PRO completion was 86% and analyses of response by key characteristics found only that participant age predicted an increased likelihood of responding to PHR and IVR outreach.


Adherence to pain-related PRO data collection using our enhanced tiered approach was high. No demographic or clinical identifiers other than age were associated with differential response by modality. Successful ancillary support should employ multimodal electronic health record functionalities for PRO administration. Using automated modalities is feasible and may facilitate better sustainability for regular PRO administration within health care systems.

Clinical Trials Registration Number: NCT02113592


patient-centered outcomes research chronic pain clinical trials primary care electronic health records 



We would like to acknowledge the following people for their efforts with developing and implementing the PRO infrastructure Reesa Laws (at KPNW) and Dana Hankerson-Dyson and Michelle Panneton (at KPGA). Many thanks to Lee Cromwell at KPGA for her analytic assistance.


UH3 NS088731 (DeBar, Lynn L.)


Collaborative Care for Chronic Pain in Primary Care (Primary Care Pain/3318)

Compliance with Ethical Standards

Institutional Review Boards at all study sites approved the study.


The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US Government.

Prior Presentations

Lancaster, L., Owen-Smith, A., Rowley, A., Laws, R., Bonifay, A., Mayhew, M. & DeBar, L.L. (2016). Automating collection of patient-reported outcomes to enhance clinical care and research. Poster presentation for the American Pain Society 35th Annual Scientific Meeting, May 11–14, 2016.

Conflicts of Interest

Ashli Owen-Smith, Meghan Mayhew, Alexandra Varga, Lindsay Benes, Allison Bonifay, and Lynn DeBar have no conflicts of interest to report. Michael C. Leo received grant funding from several for-profit companies over the past 3 years, each of which is listed below:


(Naleway, Allison L., PhD) 11/14–05/17

Improving immunization coverage in young adolescents (DAIS/3804)

Prelude Corp.

(Linke, Steven, PhD) 3/15–12/16

Multi-marker prognostic profile to predict invasive progression in DCIS patients (Prelude DCIS/3228)


Vesco (PI) 01/14–08/16

Improving diagnosis and management of vulvovaginal atrophy, a health system approach (Pfizer VVA)

GenomeDX Biosciences Inc.

Glass (PI) 06/13–08/14

Validation of a genomic signature for predicting clinical progression (CP) in prostate cancer patients after radical prostatectomy (RP) in a community-based hospital setting (Genome DX Project)


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Ashli Owen-Smith
    • 1
    • 2
  • Meghan Mayhew
    • 3
  • Michael C. Leo
    • 3
  • Alexandra Varga
    • 3
  • Lindsay Benes
    • 3
    • 4
  • Allison Bonifay
    • 3
  • Lynn DeBar
    • 5
  1. 1.Division of Health Management and Policy, School of Public HealthGeorgia State UniversityAtlantaUSA
  2. 2.Kaiser Permanente Center for Clinical and Outcomes ResearchAtlantaUSA
  3. 3.Kaiser Permanente Center for Health ResearchPortlandUSA
  4. 4.University of Portland, School of NursingPortlandUSA
  5. 5.Kaiser Permanente Washington Health Research InstituteSeattleUSA

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