Transcript PowerPoint-presentation

SQRP
SWEDISH QUALITY REGISTRY FOR PAIN
REHABILITATION
Marcelo Rivano Fischer, PhD
Head of Dept. Rehabilitation Medicine, University Hospital
President, Swedish Pain Society
Chairman, Swedish Quality Registry for Pain Rehabilitation
SQRP
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Organisation from 1 januari 2011
Chairman
Marcelo Rivano Fischer, Head of Department, Psych PhD, Lund
Coordinator
Elisabeth Persson, Leg Arbetsterapeut MSc, PhD student, Lund
Board
Björn Gerdle, Professor, MD, Linköping
Britt-Marie Stålnacke, Ass Prof, MD, Umeå
Margareta Fridén, Occup T, Jönköping
Marie-Louise Schult, Occup T, PhD, Stockholm
Harriet Brännström, Phys T, Umeå
Statistician/Coordinator to UCR
Annelie Inghilesi Larsson, PolMag Statistics, Umeå
Center of excellence
Uppsala Clinical Research Center UCR
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Goals:
1. Support member units in their quality improvement activities
2. Serve as base for developing evidence-based methods
3. Establish adequate comparisons with other units for improvement in
national standards of pain rehabilitation
NRS uses the ICF framework and groups its instruments into the categories
of function, activity/participation, and personal factors
NRS uses mainly patient related outcome measurement, PROM
Several scientific works are produced from register data
Since 2007 are results from the units open to public scrutiny
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Instruments in NRS
Questionnaire, socio-demographic data, work, sick-leave, pain duration
and attitudes towards the future.
Numeric Rating Scale (skala 0-10) (Turk m fl, 1993).
The Hospital and Anxiety Depression Scale (HAD) (Zigmond & Snaith,
1983).
Multidimensional Pain Inventory (MPI) (Kerns m fl. 1985; Rudy & Turk,
1987).
SF- 36 Health Related Life Quality (Ware, 1992; Sullivan m fl., 1998).
EQ-5D Experienced Health (the EuroQol Group) (Brooks R, 1996; van Agt m
fl., 1994)
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Patients referred to multimodal/interdisciplinary pain rehabilitation due to
complex persisting pain (non-cancer, > 3 months)
During 2010, twenty units delivered data
18 out of 20 Swedish provinces/regions are represented in NRS
Most of Swedish rehabilitation units departments are NRS members
Seven new units joined NRS during 2011 and two units left the register as they
lost their local procurements.
SQRP
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Data from 3651 patients entered 2010 at first contact (initial)
67% of referrals from GPs
1863 patients were offered pain rehab program after pain team screening
Pain team screening only, for 1788 patients
During 2010, 1394 patients completed their pain rehab programs
Pain rehab patients were mainly women ( 74%), with average pain duration
of 72 months and out of work for 22 months (median)
Worst pain was described by patients going through pain rehab programs as
varying in localisation (36%), followed by low back pain (19%) and by pain in
the neck region (14%).
SQRP
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
One year follow up
2010, 842 patients out of 1272 that went through pain rehab programs 2009
answered their one year follow up forms
It means that follow up coverage for patients in rehab 2009 was around
65%.
Out of the 842 follow up patients, 189 had incomplete set of answers
(admission, discharge, follow up) and therefore excluded from analyses.
Attrition of patients answering at follow up is therefore 23%
SQRP
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Average waiting time for patients undergoing pain team screening
only during 2010 was 68 days (median)
Fourteen out of 20 units make first contact with patients within the
health care mandatory timeframe (less than 90 days)
Seven units make first contact in less than 60 days
Average waiting time for patients undergoing pain rehab programs
during 2010 was 55 days (median)
Fifteen out of 20 units initiate pain rehab within the health care
mandatory timeframe (less than 90 days)
Eight units in less than 60 days.
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Do you feel you were responded to in a respectful and considerate way?
Were you satisfied with the unit’s equipment?
How was the information you received about practical matters?
Do you feel you were participating in the planning of your own rehabilitation?
How did the rehab team worked together in your case?
Did your relatives participate in your rehabilitation?
Did the rehabilitation period change your pain experinces?
Did the rehabilitation period change your ability to cope with your life situation?
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
NRS självskattningsprofil
Country of birth
Level of education
Age
Days since pain onset
Days with persisting pain
Days with full absence from work
Importance of work
How possible return to work
When possible return to work
Convinced about being restored
Pain last week (NRS)
MPI: pain intensity
Pain spread
Main pain localisation
MPI: affective distress
HAD: anxiety
HAD: depression
Vitality (SF-36)
Physical function, PF (SF-36)
MPI: activity index
Role function, RP (SF-36)
Social Function, SF (SF-36)
MPI: Life disturbance
MPI: Life control
Since 2010, improvements are defined, for all measures besides SF-36 and
EQ-5D, in terms of clinically meaningful improvements, that is, differences
that had been found significant by research for the health of patients, rather
than statistically significant positive differences.
Patients improved in most measures: 40-60% at discharge and 30-70% at
follow up.
Variation in improvements between the units is large for some measures
and quite small for others.
Comparison between units demands an analysis about differences and
similarities in the rehab programs offered at the different places. This
analysis is planned to be published in next year rapport.
Specific analyses show that age, pain intensity at admission, and ethnicity
are related to improvements as captured by several instruments
SQRP
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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Antal dagar
2010, number of patients by unit
Patienter per enhet 2010
700
600
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500
400
Rehabilitering
300
200
100
0
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Enbart
Utredning
2010, number of days that patients are within the
responsability of the unit, screening team
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
2010, number of days that patients are within the
responsability of the unit, pain rehab team
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
2010, Pain onset, screening teams
Smärtdebut
Utredning
140
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
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2010, Pain onset, pain rehab teams
Smärtdebut
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Månader
100
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Sv
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
2010, patients born in Sweden, pain rehab teams
Född i Sverige
Rehabilitering
100
90
80
70
60
%
50
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Reduced pain, follow up
Minskad smärta enkät
Uppföljning
R
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%
100
90
80
70
60
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Better ability to cope with life
situation, follow up
Bättre förmåga hantera livssituationen
enkät Uppföljning
100
90
80
70
60
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%
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
-5
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%
SQRP
SF VA
-3 S
6
SF
SF (P
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6
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EQ
Improvement, all instruments, admission-follow up
Samtliga instrument
Initialt - uppföljning
100
90
80
70
60
50
40
30
20
10
0
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
SF 36 Uppföljning
In
PF
90
Av
80
MH
70
Upp
RP
60
Svensk
norm
50
40
30
20
10
RE
0
BP
SF
GH
VT
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SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Persisting pain patients experience their health poorer than, for
instance, spinal cord injured people
They experience their pain as invisible and themselves under
suspicion (pain in the head)
They report being systematically de-legitimized
They experience their encounters with health care and other
authorities as frustrating and negative
Research shows ways for improvement
Registries help us to improve our strategies
SQRP
SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION
Disclosure Statement of Financial Interest
I, Marcelo Rivano Fischer, DO NOT have a
financial interest/arrangement or affiliation with
one or more organizations that could be
perceived as a real or apparent conflict of
interest in the context of the subject of this
presentation.