Transcript Document

PAIN ASSESSMENT

TWO TYPES OF PAIN.

PHYSICAL

PSYCHOLOGICAL.
PHYSICAL
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Real pain from a physical injury or
medical condition.
PSYCHOLOGICAL
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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
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DETERMINING IF PAIN IS
PSYCHOLOGICAL OR PHYSICAL.
ANSWER TO PROBLEM
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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
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In determining treatment a medical
practitioner must use a comprehensive
tool that address both the physical and
psychological.
HOW TO DO THIS
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By documenting medical outcomes
thru Pain Assessment
PAIN ASSESSMENT
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A Pain Assessment must addresses both
the physical and psychological aspect of
the patients condition.
PROCEEDURE
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Outcome Assessment
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Collection and recording of information
relative to health processes
Outcome Management
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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

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Utility
Reliability
Validity
Sensitivity
Is it useful?
Is it dependable?
Does it do what it is supposed to?
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
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Questionnaires
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General health status
Pain
Functional status
Patient satisfaction
Physiological outcomes
Utilization measures
Cost measures
APPROPRIATELY USED
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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
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Health Care Customer - Meaning of Outcomes
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Payers-purchasers
Regulators
Administrators
Clinical Researchers
Outcomes Experts
Health Care Providers
Cost containment
HCP compliance
Efficiency-low utilization
Proof of a premise
Patient’s benefit
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
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Subjective outcomes assessment information
is gathered by the patient in self-administered
questionnaires and scored by either the:
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Health care provider
Staff members or
By a computer.
SUBJECTIVE QUESTIONNAIRES
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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
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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
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Subjective
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(Patient Driven)
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General Health
Pain Perception
Condition or Disease
Specific
Psychometric
Disability Prediction
Patient Satisfaction
Objective
(HCP Driven)
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Range of Motion
Strength - Endurance
Non organic
Proprioception
Cardiopulmonary
Developmental
ASSESSMENT TOOLS
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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)
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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)
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The application of a PAQ should, at minimum,
be used at the following intervals:
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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
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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
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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
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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
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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.
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Yeomans SG: The Clinical Application of Outcomes Assessment, Stamford
Connecticut, Appleton & Lange, 2000
PAIN PERCEPTION
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Visual Scales
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Reliable and valid
Advantages of measurement methods
Pain Word Inventory
Pain Drawing
(Scott and Huskisson 1976, Price et al 1994).
PAIN ASSESSMENT OFFERS:
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Four specific factors - Von Korff et al,
1992
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CURRENT Pain Level
AVERAGE or TYPICAL Pain Level
Pain level at its BEST
Pain level at its WORST
Final Assessment
GUIDELINES
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Chronic Patient
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Average Pain = Last 6 months
Frequency
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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
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Outcome measures for the upper and lower
extremities. “this dispels the myth that socalled 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
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Distress and Risk Assessment
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Pain perception questionnaire that
incorporates both physical and
psychological conditions.
4 STEPS TO
BECOME OUTCOMES BASED
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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”
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The fully developed clinical record
defines the “medical necessity” of the
case in the eyes of the insurer.
“MEDICAL NECESSITY”
DOCUMENTATION
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Provider must document
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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
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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
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There is potential for increased billing
utilizing Pain Assessments.
Insurance billing codes cover Pain
Assessments and Doctor’s consultations
Danard-Lilly, Corporation

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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