Abstract ID: A27

Abstract Title: Technical Report: Use of an Outcomes Database in a Community Pain Clinic

Authors: Merrill D
         Virginia Mason Clinic Seattle WA USA
Poster Type: Either


ABSTRACT BODY

INTRODUCTION:
Monitoring of outcomes data is a recognized requirement for evaluation of therapeutic efficacy as well as a significant component of any quality improvement program. This is a report of the use of a Microsoft Access™ database to provide an efficient and relatively inexpensive yet robust means of evaluating such outcomes.
METHODS:
One physician and one programmer created a database using Microsoft Access™ to allow input of pre-procedure patient questionnaire (written) responses, demographic information and post procedure outcome and questionnaire information. Patients were informed that their responses were to be entered into a medical database for the purpose of tracking their progress as well as determining the value of these treatments in general. As this follow-up information has always been gathered as an integral function of the patient's care, specific additional written consent was not obtained.
Questions were created de novo and from the Lumbar Spine Baseline Questionnaire (c. 2000, AAOS/NASS/SRS/CSRS/ORS/ASIA/COSS). Patients were contacted by phone to report on progress and the questions were asked in a stereotypical fashion. Those patients who could not be reached by phone were contacted by mail with the same stereotypical questions. All data were entered by RNs. For this report, HIPAA compliance was assured by scrubbing patient information upon extraction reporting.
The cost of professional help in creating the database was approximately $2500 and the software was less than $200.
RESULTS:
For the purposes of this report, two procedures by two physicians were evaluated. Over the first 6 months of 2005, two physicians saw 72 patients who underwent one or more lumbar epidural steroid injections and 24 who underwent one or more cervical epidural steroid injections. Each patient saw only one of the physicians. Representative results monitoring change in self-report from day of first procedure to day 90 callback for these 96 patients are portrayed in the accompanying graphics.
DISCUSSION:
The intent of this abstract is to portray the relative ease with which a very small pain clinic can monitor useful data regarding patient outcomes. In this case, only patient self-reported data were collected. It would be feasible for independent observation by therapists (physical, occupational, and behavioral) to be quantified and tracked, as well.
This work is primarily limited by the effects of the many factors (medication, therapy, work type, disability actions, litigation) that affect outcomes in the course of chronic pain that cannot be controlled or sometimes even detected by pain clinicians. As well, patient self-reporting has limitations. Each of these limiting factors may play a role in the seeming disconnection between improvements in patients’ self-rating of pain vs. their self-rating of activity, work, quality of life and value of the procedures. Finally, although aggregate data was presented here, value is found in the ability to track individual patients longitudinally.
CONCLUSION:
Useful outcome monitoring can be implemented by the smallest of clinics using off-the-shelf software with a modest amount of professional programming help.


ATTACHED FILES

A27_ABSTRACTCHART62310.xls

A27_ABSTRACTCHART62311.xls

A27_ABSTRACTCHARTBOTH.xls

Reg Anesth Pain Med 2005; 30(3):A27