A Sustainable Stepwise Approach for Improved Functional Outcomes

This presentation will outline 3 sustainable stepwise approaches for providing chronic pain care within the patient centered medical home (PMH). Treatment of chronic pain is going through a systemic transformation (see 2016 National Pain Strategy from HHS and the 2009 VHA Stepped Care Model). The biopsychosocial, multidisciplinary, stepped-care model provides a 3-step continuum of efficient pain care leading to the goal of sustainable functional improvement for the patient. Stepwise pain management increases patient access to evidence based treatment while reducing the potentially dangerous use of opioids. Authorizing staff to work at the peak of their licenses allows the PMH to utilize a variety of staff for managing chronic pain through shared medical appointments, case management, and educational instruction. Timely access to each step enhances multiple outcomes for patients with chronic pain, including focusing on improvements in functional status rather than changes in pain intensity, increasing dependence upon self-care strategies, and establishment of pathways for patient-provider agreement on opioid safety goals. Quality improvement examples, treatment guidelines, educational tools, enhanced sustainability and efficiency recommendations, and clinical process goals will be provided. (Recorded at PAINWeek 2016)