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Using a Co-design Approach to Improve Pain Assessment and Management

MHQP is working with Mad*Pow, a creative design firm, on an exciting, groundbreaking project to explore alternatives to the current ways we assess and manage pain to better calibrate pain assessment with opioid prescribing. The initiative is funded by CIGNA. Barbra Rabson provides details…

Why did MHQP get involved in this initiative?

MHQP got involved in this initiative with a desire to help reduce the burden of the opioid crisis and improve care for patients in pain. We had a strong belief that MHQP could be helpful in this effort because of two fundamental philosophical pillars that drive all of our work:  first, that the experiences of patients and families are key to helping us improve how we provide care; and second, that we can best solve problems in our health care system by bringing all stakeholders together to help co-design solutions. We had a shared belief that the tools we currently use to assess pain, and the way we communicate with patients about managing their pain in this country is dysfunctional – that it is terribly flawed and leads to unnecessary suffering.

What’s the problem you’re trying to solve?

We’re trying to reduce the impact of the opioid crisis by developing a better way for patients to report pain levels to providers. The current opioid crisis is an issue of great importance and concern for many stakeholders: opioid users, their families, patients in pain, health care providers, policy makers, and insurers/payers. The misuse of opioids escalated notably in the mid-1990s with the introduction and marketing of new opioid drugs, and the simultaneous new emphasis on measuring pain as “a fifth vital sign.” In 2011, the Institute of Medicine’s report on Relieving Pain in America noted that significant improvements are needed to ensure pain assessment techniques and practices are high-quality and comprehensive. We believe there is a critically important opportunity to improve how we assess and manage pain, which can in turn lead to more appropriate prescribing of opioids.

So, what is MHQP doing about it?

Thanks to a generous grant from CIGNA, we’ve started a project to hopefully discover an approach to assessing pain that is better than the traditional 10-point scale. We’ve partnered with Mad*Pow, a human-centered design firm, to help us create a design process. We just completed an all-day workshop, where we brought together the various stakeholders in this process – pain specialists, researchers, providers, insurers, pharmacists, and – of course – patients. It’s amazing to me how often we forget to include the ultimate customers (patients) in a design process. But we’ve got to understand all the people we’re designing for so that our solutions make sense and are workable for the end users.

For the past several months, we’ve been interviewing experts in the field and all the different stakeholders separately to get ready for the workshop. So, we already had sense of what’s going on and what the issues are. The goal of the workshop was to come up with some testable approaches to solve the problem. We will be sharing the findings of our workshop broadly.

What did you hear from patients and providers?

We heard that the communication between patients and their providers about pain is grossly inadequate. Patients report high levels of frustration about living with pain for a long time and the sense of isolation and uncertainty that can bring. When they go to their providers for help, patients want human connection, someone to validate their experience, and they want relief from their pain. Instead they often feel dismissed. 

In our discussions with providers we’ve also heard frustration – about not having the tools, time or knowledge to relieve the pain of their patients.  We’ve heard about lots of uncertainty and guardedness about interactions with patients, due in part to sometimes being deceived by drug seekers.

What will happen to the ideas you generated at the workshop?

We’ll take the most promising ideas and do some prototype testing. That will be the second phase. And then the third phase will be to make it part of the evidence base by doing a study that can be peer-reviewed and show it’s a better approach than current practice.

In the many conversations I have had with all kinds of people about this project, I have not met a single person who had not been excited by what we are trying to do. Many are eagerly awaiting the solutions we find so they can test them out. MHQP will share the ideas about how clinicians can have better conversations with patients about pain with physician organizations and start actions that can begin to have a great impact on how we deliver care. We hope these solutions will then spread across organizations and be improved upon. 

How does this work fit with MHQP’s mission?

MHQP is focused on improving the care experience, and one of the key tenants of how we approach our work at MHQP is around the importance of engaging patients in the quality improvement process. Patients are an unutilized resource in our healthcare system. By hearing the experiences and perspectives of real patients with real problems, that’s when we’re going to be most effective at problem-solving. And pain management is a very big issue for patients – and for our society. We have heard in our interviews that assessing and managing pain is a very important issue for providers and one that is wrought with frustration and uncertainty. So, we’re bringing patients together with other stakeholders so we can learn about how we are doing things currently and what we can do to make it better. That’s how we get it right. That’s how we solve real problems.

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