Operationalizing Multidisciplinary Assessment and Treatment as a Quality Metric for Interventional Pain Practices

Quality improvement (QI) is an underutilized approach among pain medicine specialists to improve comprehensive pain assessment and the delivery of multimodal pain care. We report the results of a QI program that utilized peer review and financial incentives to improve these processes in interventional pain clinics.

Retrospective chart review.

Eight academic and community-based practices that included separate hospital-based and non-hospital-based interventional pain clinics.

Results of chart audits by nine academic pain medicine physicians.

An audit of a random sample of each pain physician's charts was periodically examined for mention and discussion of specific components of multidisciplinary pain care. A portion of the physician's incentive payment was withheld if less than 70% of charts were compliant. The rates of compliance after the intervention for the group were compared.

Before this program was instituted, an audit of 10 patient charts from each of the nine pain medicine physicians revealed only a 13% baseline rate of compliance. After the audit system was implemented, 90% of all patient charts were compliant during the first 12-month period (P < 0.01 for the change in rate of compliance).

The results of this QI project suggest that pain clinics can make this value-based transition and offer high-quality multidisciplinary assessment and treatment, with good compliance among a group of physicians in primarily intervention-based practices.