2019 MBHR Measure: Pain Interference Response utilizing PROMIS

QCDR Name: MBHR Mental and Behavioral Health Registry

Measure Title Pain Interference Response utilizing PROMIS
NQS Domain Effective Clinical Care
Measure ID MBHR3
NQF ID N/A
Measure Type Patient Reported Outcome (PRO)
High Priority? Yes
Description The percentage of adult patients (18 years of age or older) who report pain issues and demonstrated a response to treatment at one month from the index score
Denominator Adult patients (18 years of age or older) who report pain issues as significantly impacting their life

Denominator Exclusions: Patients who die or are enrolled in hospice are excluded from this measure.

Denominator Exceptions: None

Numerator The number of patients in the denominator who demonstrated a response to treatment, with a result that is reduced by 2-6 points or greater from the index score, one month (+/- 21 days) after the index visit.

The following are meaningful change scores indicated by various types of chronic pain:

  • Change of 3.5-5.5 points (used CAT with back pain samples) Amtmann
  • Change of 2-3 points (used short forms with chronic pain samples) Chen
  • Change of 3.5-4.5 points (used short forms with stroke sample) Chen
  • Change of 2.35-2.4 points (used short form with knee OA sample) Lee
  • Change of 4.0-6.0 points (used 10 item short form with cancer sample) Yost

Numerator Exclusions: None

Data Source Claims, EHR, Paper Medical Record, Registry
Meaningful Measure Area Patient Reported Functional Outcomes
Meaningful Measure Rationale Using a standardized measure to assess pain will improve both quality of treatment and efficient use of resources. Measuring improved pain response in treatment (i.e., interference) will promote interventions and best practices, such as nonpharamcological treatments, that are effective at reducing symptoms and improve functional status and quality of life.
Inverse Measure? No
Proportional Measure? Yes
Continuous Variable Measure? No
Ratio Measure No
Number of Performance Rates 1
Risk Adjusted No
Preferred Specialty mental and behavioral health
Applicable Specialties Family Practice, Internal Medicine, Geriatric Medicine, Psychiatry, Behavioral Health, Physical Therapy, Occupational Therapy, Neurology, Anesthesiology, Endocrinology, Hematology & Oncology, Neurology, Rehabilitation Medicine

Measure Justification

Pain is among the most prevalent, persistent, and costly health conditions in clinical practice as well as the general population.1 Moreover, musculoskeletal pain conditions account for four of the nine most disabling diseases.2

From: Kroenke, K. (2018). Pain Measurement in Research and Practice. J Gen Intern Med, 33:1, S7-8.

  1. Institute of Medicine. Relieving pain in America: a blueprint for transforming
    prevention, care, education, and research. Washington, DC:
    National Academies Press; 2011.
  2. US Burden of Disease Collaborators. The state of US health, 1990Ð2010:
    burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591Ð
    608.

Chronic pain, lasting present on most days for three months or longer, is experienced by an approximate 11.2% of Americans, although some surveys have estimated this to be closer to 30% common among adults with prevalence estimates as high as 40% of adults while bothersome chronic pain affects 20 to 25 percent of adults. Chronic pain with major life activity impacts affects about 10 percent of the adult population.1,2 Chronic pain is more prevalent for women than men, tends to increase with age, is mainly most commonly attributed to low back followed by and osteoarthritis pain and is reported as severe for about a third of respondents.2 But persons with persistent pain with life activity impacts frequently report pain at multiple body sites or anatomically diffuse pain. In some populations the prevalence of chronic pain may be higher, such as in up to 50% of those who are veterans.3 Chronic pain with life activity impacts is complex and unique to individual patients, often occurring along with comorbidities including obesity, depression, anxiety, and post-traumatic stress disorder.4,5,6

  1. National Center for Complementary and Integrative Health. Pain in the U.S., August, 2015. Available: https://nccih.nih.gov/news/press/08112015.
  2. Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain. 2010 Nov;11(11):1230-9.
  3. Kerns RD, Otis J, Rosenberg R, Reid MC. Veterans’ reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system. J Rehabil Res Dev. 2003 Sep-Oct;40(5):371-9.
  4. Narouze S, Souzdalnitski D. Obesity and chronic pain: systematic review of prevalence and implications for pain practice. Reg Anesth Pain Med. 2015 Mar-Apr;40(2):91-111.
  5. Stubbs B, Koyanagi A, Thompson T, Veronese N, Carvalho AF, Solomi M, et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen Hosp Psychiatry. 2016 Nov – Dec;43:63-70.
  6. Otis JD, Keane TM, Kerns RD. An examination of the relationship between chronic pain and post-traumatic stress disorder. J Rehabil Res Dev. 2003 Sep-Oct;40(5):397-405.

Psychological interventions for management of chronic pain are a useful approach according to a review of 35 studies. (2012 – https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007407.pub3/full?highlightAbstract=pain&highlightAbstract=management&highlightAbstract=chronic&highlightAbstract=manag)

Psychological interventions can reduce pain and catastrophizing beliefs, and improve pain self-efficacy for management, particularly in older adults according to a recent systematic review and meta-analysis of 22 studies. (2018 – https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2680318)

The PROMIS(r) Pain Interference instrument (adult) measures the self-reported consequences of pain on relevant aspects of a personÕs life and may include the extent to which pain hinders engagement with social, cognitive, emotional, physical, and recreational activities. Pain Interference also incorporates items probing sleep and enjoyment in life, though the item bank only contains one sleep item. The Pain Interference short form is universal rather than disease-specific. The Pain Interference items utilize a 7Ðday recall period (items include the phrase “the past 7 days”).

The PROMIS Adult Short Form v1.0 Ð Pain Interference 6b has been created as an independent instrument on this CDE website due to its unique question content. The original short form (6b) was constructed by the domain team with a focus on representing the range of the trait and also representing the content of the item bank. Domain experts reviewed short forms to give input on the relevance of each item. The original short forms are 6-10 items long. Psychometric properties and clinical input were both used and likely varied in importance across domains.
In addition, there are Pain Interference 4a, 6a, and 8a short forms, where items were selected based on rankings using two psychometric criteria: (1) maximum interval information; and (2) CAT simulations. Item rankings were similar for both criteria. These 4-item, 6-item and 8-item forms have been selected so that the items are nested (e.g., the 8-item form is the 6-item form plus two additional items). The 4a, 6a, and 8a short forms can be administered individually or as part of a PROMIS Profile (see PROMIS-29, 43 or 57 Profiles).
In selecting between short forms, the difference is instrument length. The reliability and precision of the short forms is highly similar. If you are working with an adult sample in which you wanted the most precise measure, select the 8a short form. If you are working in an adult sample in which you expected huge variability in a domain area and wanted different subdomains covered, you should select the 6b short form.
Excerpted from: https://cde.drugabuse.gov/instrument/0a47fbff-5f72-2281-e050-bb89ad4358ae