PAIN ASSESSMENT

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PAIN ASSESSMENT

• TWO TYPES OF PAIN.
• PHYSICAL
• PSYCHOLOGICAL.

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PHYSICAL

• Real pain from a physical injury or medical
  condition.

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PSYCHOLOGICAL

• A condition where pain is felt when no actual
  physical or medical condition exists.

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QUESTION

• He/she is a pain in the _______
  (You fill in the blank)
• Is this physical or psychological?

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MEDICAL PRACTIONERS PROBLEM

• DETERMINING IF PAIN IS PSYCHOLOGICAL OR PHYSICAL.

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ANSWER TO PROBLEM

• Its 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

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DETERMINING TREATMENT

• In determining treatment a medical practitioner
  must use a comprehensive tool that address both
  the physical and psychological.

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HOW TO DO THIS

• By documenting medical outcomes thru Pain
  Assessment

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PAIN ASSESSMENT

• A Pain Assessment must addresses both the
  physical and psychological aspect of the patients
  condition.

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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)

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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).

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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)

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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).

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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?

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APPROPRIATE FOR CLINICAL USE

• Questionnaires
• General health status
• Pain
• Functional status
• Patient satisfaction
• Physiological outcomes
• Utilization measures
• Cost measures

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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)

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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 Patients 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)

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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.

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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).

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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).

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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

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ASSESSMENT TOOLS

• It is important to remember to utilize the same
  outcome assessment tool through the course of
  case management with each patient.

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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

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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.

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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).

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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.

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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.

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OUTCOME-BASED PRACTICE

• Correlating this information to the patients
  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

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PAIN PERCEPTION

• Visual Scales
• Reliable and valid
• Advantages of measurement methods
• Pain Word Inventory
• Pain Drawing
• (Scott and Huskisson 1976, Price et al 1994).

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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

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GUIDELINES

• Chronic Patient
• Average Pain Last 6 months
• Frequency
• Every 4 to 6 weeks since a patients failure to
  progress may indicate a need for a change in
  management approaches
• (Haldeman et al, 1993).

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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)

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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)

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Psychometric Assessment Tool

• Distress and Risk Assessment
• Pain perception questionnaire that incorporates
  both physical and psychological conditions.

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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

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Medical Necessity

• The fully developed clinical record defines the
  medical necessity of the case in the eyes of
  the insurer.

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MEDICAL NECESSITY DOCUMENTATION

• Provider must document
• Etiology of complaint
• (onset, severity, frequency , duration
• Patients health history
• Current subjective complaints
• Current objective clinical findings
• Diagnosis
• Treatment plan
• Measurements of patient improvement (outcome
  assessment)

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HELPS TO EXPOSE FRAUDULENT CLAIMS

• Continued use of Pain Assessments could expose
  inconsistencies in claims limiting insurance
  liability.
• Verifies insurers proof for needed care.

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Increase Revenues by Utilizing Pain Assessments

• There is potential for increased billing
  utilizing Pain Assessments.
• Insurance billing codes cover Pain Assessments
  and Doctors consultations

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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.

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Danard-Lilly, Corporation
P.O. Box 512 Sunset Beach, CA 90742 (714) 385
1131 Email Danardlilly_at_Yahoo.com Web Site
www.danardlilly.com