PAIN ASSESSMENT
TWO TYPES OF PAIN.
PHYSICAL
PSYCHOLOGICAL.
PHYSICAL
Real pain from a physical injury or medical condition.
PSYCHOLOGICAL
A condition where pain is felt when no actual physical or medical condition exists.
QUESTION
He/she is a pain in the _______ (You fill in the blank)
Is this physical or psychological?
MEDICAL PRACTIONER’S PROBLEM
DETERMINING IF PAIN IS PSYCHOLOGICAL OR PHYSICAL.
ANSWER TO PROBLEM
It’s both.
Psychological distress can cause headache, stomach cramps and nausea which is physical.
The medical practitioner has to determine the psychological impact on the physical pain
DETERMINING TREATMENT
In determining treatment a medical practitioner must use a comprehensive tool that address both the physical and psychological.
HOW TO DO THIS
By documenting medical outcomes thru Pain Assessment
PAIN ASSESSMENT
A Pain Assessment must addresses both the physical and psychological aspect of the patients condition.
PROCEEDURE Outcome Assessment
Collection and recording of information relative to health processes
Outcome Management Using information in a way that
enhances patient care (Hansen DT, Mior S, Mootz RD in Yeomans SG: The
Clinical Application of Outcomes Assessment, Stamford Connecticut, Appleton & Lange, 2000)
OUTCOME ASSESSMENTS/MANAGEMENT
Outcomes in clinical practice provide the mechanism by which the health care provider, the patient, the public, and the payer are able to assess the end results of care and its effect upon the health of the patient and society. (Anderson & Weinstein, 1994).
HEALTH POLICY
With the dawning, of the “era of accountability,” there are new social mandates directed toward health care providers and health-related facilities. Measurements of quality, satisfaction, efficacy, and effectiveness now serve as essential elements for health care decisions and matters of health policy.
(Hansen DT, Mior S, Mootz RD in Yeomans SG: The Clinical Application of Outcomes Assessment, Stamford Connecticut, Appleton & Lange, 2000)
SURVIVAL
To survive, in fact to flourish, in this era of accountability health care providers must be prepared to maintain and be able to provide appropriate documentation and patient records in a clinically efficient and economical manner. (Hansen, 1994).
OUTCOMES CRITERIA
Utility Is it useful? Reliability Is it dependable? Validity Does it do what it is supposed to? Sensitivity Can it identify patients with a
condition? Specificity Can it identify those that do not
have the condition? Responsiveness Can it measure differences
over time?
APPROPRIATE FOR CLINICAL USE Questionnaires
General health status Pain Functional status Patient satisfaction
Physiological outcomes Utilization measures Cost measures
APPROPRIATELY USED
When outcome measures are appropriately used and integrated into an evidence-based, patient-centered model of practice, there is accountability and quality assurance.
(Hansen DT, Mior S, Mootz RD in Yeomans SG: The Clinical Application of Outcomes Assessment, Stamford Connecticut, Appleton & Lange, 2000)
OUTCOME MEANINGS
Health Care Customer - Meaning of Outcomes
Payers-purchasers Cost containment Regulators HCP compliance Administrators Efficiency-low utilization Clinical Researchers Proof of a premise Outcomes Experts Patient’s benefit Health Care Providers Clinical-Health Status
(Hansen DT, Mior S, Mootz RD in Yeomans SG: The Clinical Application of Outcomes Assessment, Stamford Connecticut, Appleton & Lange, 2000)
SUBJECTIVE QUESTIONNAIRES
Subjective outcomes assessment information is gathered by the patient in self-administered questionnaires and scored by either the:
Health care provider Staff members or By a computer.
SUBJECTIVE QUESTIONNAIRES
In spite of the definition associated with the term “subjective,” these “pen-and-paper tools” have been described as very valid and reliable – in many cases more so than many of the “objective’ tests that health care providers have relied upon for years.
(Chapman-Smith, 1992; Hansen, 1994; Mootz, 1994).
SUBJECTIVE VS OBJECTIVE
It must be emphasized that although the term “subjective” carries negative connotations, the reliability/validity data published regarding these methods of collecting outcomes is exceptional, typically out-performing the test-retest reliability and validity of most “objective” physical performance tests.
(Chapman-Smith, 1992).
OUTCOME CLASSIFICATION
Subjective
(Patient Driven)
General Health Pain Perception Condition or Disease
Specific Psychometric Disability Prediction Patient Satisfaction
Objective
(HCP Driven)
Range of Motion Strength - Endurance Non organic Proprioception Cardiopulmonary Developmental
ASSESSMENT TOOLS
It is important to remember to utilize the same outcome assessment tool through the course of case management with each patient.
PSYCHOLOGICAL AND GENERAL HEALTH QUESTIONNAIRES (GHQ)
One can benefit from the use of a Psychological and GHQ because it is not condition-specific and, therefore, can be applied to virtually any complaint.
Yeomans SG: The Clinical Application of Outcomes Assessment, Stamford Connecticut, Appleton & Lange, 2000
APPLICATION OF PAIN ASSESSMENT QUESTIONNAIRES
(PAQ)
The application of a PAQ should, at minimum, be used at the following intervals:
At the time of the initial presentation for baseline establishment of outcomes assessment.
To identify problems for prompt management. At 4 to 6 week plateau in care or discharge for
outcomes assessment of the treatment benefits or lack thereof.
Six months after discharge in order to evaluate the long-term benefits of treatment.
SYMPTOM INVENTORY QUESTIONNAIRE
This can serve as a very practical reference tool to use for patient report of findings, to insurers to justify “medical necessity” for additional care, and to the health care provider to facilitate the decision making process of case management (referral, discharge).
PAIN WORD INVENTORY
Established as the standard by which other psychological instruments for pain measurement are compared
Consists of 86 descriptor words divided into twenty-one categories
Categories divided into 4 Classifications.
PAIN DRAWING
Developed by Danard Lilly Corporation to show the front and back body drawing with numbers to map the nature and distribution of pain.
OUTCOME-BASED PRACTICE
Correlating this information to the patient’s specific clinical data and then making a clinical decision based on the results represents a difficult but important step in making a “paradigm shift” into becoming an “outcome-based” practice.
Yeomans SG: The Clinical Application of Outcomes Assessment, Stamford Connecticut, Appleton & Lange, 2000
PAIN PERCEPTION Visual Scales
Reliable and valid Advantages of measurement methods Pain Word Inventory Pain Drawing (Scott and Huskisson 1976, Price et al 1994).
PAIN ASSESSMENT OFFERS:
Four specific factors - Von Korff et al, 1992 CURRENT Pain Level AVERAGE or TYPICAL Pain Level Pain level at its BEST Pain level at its WORST
Final Assessment
GUIDELINES
Chronic Patient Average Pain = Last 6 months
Frequency Every 4 to 6 weeks since a patient’s
failure to progress may indicate a need for a change in management approaches
(Haldeman et al, 1993).
QUESTIONNAIRE MEASURES
Outcome measures for the upper and lower extremities. “this dispels the myth that so-called soft (subjective) outcomes are less valuable when compared to objective measures when, in fact, the subjective measures are often more sensitive, specific, and responsive than many objective measures.” (Koran, 1975)
Assessment Validity
An assessment and traditional physical examination measures of median nerve function capture different but complementary outcome information. Therefore, symptom severity and functional status cannot be reliably compared to sensibility or nerve conduction testing.”
(Levine et al, 1993)
Psychometric Assessment Tool
Distress and Risk Assessment
Pain perception questionnaire that incorporates both physical and psychological conditions.
4 STEPS TO BECOME OUTCOMES BASED
Utilize subjective/objective tools Score the tools at the initial visit to
establish baseline measures Repeat the instrument after 4-6 week
intervals to track the effects of treatment changes
Base clinical decisions on the outcome results
“Medical Necessity”
The fully developed clinical record defines the “medical necessity” of the case in the eyes of the insurer.
“MEDICAL NECESSITY” DOCUMENTATION
Provider must document
Etiology of complaint(onset, severity, frequency , duration
Patient’s health history Current subjective complaints Current objective clinical findings Diagnosis Treatment plan Measurements of patient improvement
(outcome assessment)
HELPS TO EXPOSE FRAUDULENT CLAIMS
Continued use of Pain Assessments could expose inconsistencies in claims limiting insurance liability.
Verifies insurers proof for needed care.
Increase Revenues by Utilizing Pain Assessments
There is potential for increased billing utilizing Pain Assessments.
Insurance billing codes cover Pain Assessments and Doctor’s consultations
Danard-Lilly, Corporation
Clinical analysis and innovative technology has produced the only complete advanced Pain Assessment Tool in the industry that covers both the physical and psychological.
Provides complete, consistent and efficient patient care.
Reduces patient recovery time by 20% - 30%. Helps to expose fraudulent claims. Breaks the language barrier between doctors
and patients.
Danard-Lilly, Corporation
P.O. Box 512
Sunset Beach, CA 90742
(714) 385 1131
Email: [email protected]
Web Site: www.danardlilly.com
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