Background
Overview
Description of Electronic Health Record (EHR) and Pain Health Assessment (PHA) Tool
Data content of electronic health record
Category | Variables | Comment |
---|---|---|
Demographic & Lifestyle | 5 administrative 11 from PHA | |
Treatment codes | 1 to 33 per patient | Mean = 5.7 |
Drug codes | 1 to 13 per patient | Mean = 3.4 Drugs used for procedures |
Prescription Drugs | 10 major classes | 90 % of all Rx in top 10 classes Mean = 4.6 Rx per patient ~27 % of patients receive Rx |
Diagnosis codes | 1 to 17 per patient | Mean = 3.7 |
PHA Questionnaire | 163 items representing multiple scales and sub-scales | Patient-reported status and outcomes. Additional items are included for narcotic risk, demographics and lifestyle. |
Progress Notes | ||
Canonical sections | 8 | |
Extractable variables | Unknown | Estimates from preliminary work would indicate at least 10 variables per section |
Historical background: development and deployment of the PHA
PHA Categories | Response types | items | Comment |
---|---|---|---|
Demographic | y/n item select | 5 | 2 items in iPHA only |
Lifestyle & abuse history | Item select | 11 | 8 items in iPHA only |
Employment & disability | y/null | 20 | In both iPHA and cPHA |
Syndromes & Diagnoses | y/null | 15 | In both iPHA and cPHA |
Pain anatomic location | y/null | 17 | iPHA only |
Biopsychosocial (total) | 11-pt Likert | 95 | |
iPHA only | 11-pt Likert | 7 | Initial panel: Pain interference with daily life |
cPHA only | 11-pt Likert | 21 | Outcomes and satisfaction |
Questions | PHA (Pain Health Assessment) descriptive labels |
---|---|
Q1 | Ethnicity |
Q2 | Race |
Q3 A – Q | Symptoms |
Q4 A – O | Syndromes and Diagnoses |
Q5 A – B | Worst and Least Pain Today |
Q6 A – G | Pain interfering (past 24 h) with activity, mood,walking, work, relationships, sleep, and enjoyment of life |
Q7 | Estimate of health |
Q8 A – B | Health limiting moderate activity, strenuous activity during typical day |
Q9 A – B | Health (past 4 weeks) limiting accomplishments or work |
Q10 A – B | Emotional problems (past 4 weeks) limiting accomplishments or work |
Q11 | Pain (past 4 weeks) interfering with work |
Q12 A – C | Feelings (past 4 weeks); calm and peaceful, lot of energy, downhearted and depressed |
Q13 | Physical or emotional health (past 4 weeks) interfering with social activities |
Q14 | Health compared to one year ago |
Q15 A – C | Worst pain, average pain, pain right now |
Q16 A – P | Activities of daily living |
Q17 A | Physical activity makes me hurt more |
Q17 B – D | Preconceptions; activity make me feel better, safe for me to be active, I should do normal work |
Q18 A - K | Feelings (past 4 weeks). Pep, nervous, down in dumps, worn out, happy, tired, anxious, worry, angry, depressed, memory problems |
Q19 A – F | Pain getting in the way of; enjoying social activities, doing social activities, family relationships, friend relationships, pleasure with family, ability to plan |
Q20 A – D | Perception of control; life, handling problems, control of pain, coping with stress |
Q21 A – D | Time devoted to; visiting friends, partaking in groups, enjoying hobbies, activities outside the house |
Q22 A – D | Limitations (past 4 weeks), time on work or activities, accomplishments, performance |
Q23 | Initial pain before treatment |
Q24 | Average daily pain at this point in treatment |
Q25 | Relief received from treatments and medications |
Q26 A - G | Improvement in; activity, mood, walking, work, relationships, sleep, enjoyment of life |
Q27 A - K | Rating of clinical experience; time, courtesy, confidence, quality, administration, confidence of recommendations |
Q28 A - M | Questions regarding employment status and disability |
Q29 A - G | Specific questions regarding disability support |
Q30 | Marital status |
Q31 | Persons in household |
Q32 | Education |
Q33 | Smoking habits |
Q34 | Alcohol use |
Q35 | History of substance abuse |
Q36 | Family history of substance abuse |
Q37 | Preadolescent sexual abuse |
Q38 | Who completed PHA |
Q39 | How was PHA completed |
Current deployment characteristics
Methods
Data
Measures and analyses
Factor analysis
Outcome analysis
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Ques.1. Overall, how much relief have you received from pain treatments and medications? Please fill in the percentage that shows how much relief you have received. (0–10) 0 % - 100 %;
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Ques.2. “On a scale of 0–10, please rate your average pain in the past 4 weeks”;
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Ques.3. “Fill in the number that best describes your average daily pain at this point in treatment at the pain management center. Please rate (0–10) No pain – worst pain”;
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Ques.4. “On a scale of 0 to 10… Your control over your pain. (0–10) Complete – None”
Results
Exploratory factor analysis
Factor | Informal factor description | # of items | Mean loading | Mean alpha | Mean communality | Variables in factor |
---|---|---|---|---|---|---|
1 | Pain on ADL - torso | 9 | 0.726 | 0.945 | 0.726 | Q6-C, Q8-B, Q16-I, Q16-J, Q16-K, Q16-L, Q16-M, Q16-N, Q16-O |
2 | Pain affecting work | 8 | 0.600 | 0.943 | 0.758 | Q8-A, Q9-A, Q9-B, Q11, Q22-A, Q22-B, Q22-C, Q22-D |
3 | Mental health | 8 | 0.565 | 0.901 | 0.563 | Q12-C, Q18-B, Q18-days, Q18-G, Q18-H, Q18-I, Q18-J, Q18-K |
4 | Pain on ADL – fine motor | 6 | 0.644 | 0.894 | 0.618 | Q16-A, Q16-B, Q16-C, Q16-D, Q16-E, Q16-H |
5 | Pain intensity | 6 | 0.670 | 0.865 | 0.554 | Q5-A, Q5-B, Q6-F, Q15-A, Q15-B, Q15-C |
6 | Social interactions | 4 | 0.554 | 0.848 | 0.621 | Q19-C, Q19-D, Q19-E, Q19-F |
7 | Coping ability | 3 | 0.692 | 0.900 | 0.745 | Q20-A, Q20-B, Q20-D |
8 | Effects of pain – past 24 h | 5 | 0.532 | 0.900 | 0.686 | Q6-A, Q6-B, Q6-D, Q6-E, Q6-G |
9 | Social activities | 4 | 0.534 | 0.811 | 0.530 | Q21-A, Q21-B, Q21-C, Q21-D |
10 | Mental state affecting work | 2 | 0.791 | 0.964 | 0.878 | Q10-A, Q10-B |
11 | Pain affecting hobbies | 2 | 0.452 | 0.930 | 0.816 | Q19-A, Q19-B |
12 | Vitality - pep | 3 | 0.751 | 0.738 | 0.485 | Q12-A, Q12-B, Q18-A |
13 | Pain affecting jaw | 2 | 0.666 | 0.864 | 0.672 | Q16-F, Q16-G |
14 | Vitality - tiredness | 2 | 0.632 | 0.825 | 0.520 | Q18-D, Q18-F |
15 | Pain-work attitude | 3 | 0.446 | 0.690 | 0.463 | Q17-B, Q17-C, Q17-D |
Question | Paraphrased question content |
---|---|
Q7 | In general would you say your health is: (0–10), (excellent – poor) |
Q13 | In past 4 weeks how much has health or emotions limited social activity (0–10), (none of time – all of time) |
Q14 | Compared to one year ago, how do you rate your health (0–10), (much better – much worse) |
Q16-P | Does your health now limit you in sitting: (0–10), (not at all – a lot) |
Q17-A | Physical activity makes me hurt more (0–10), (completely agree – completely disagree) |
Q18-E | How are you feeling in past 4 weeks: Have you been a happy person? (0–10), (none of time – all of time) |
Q20-C | Your control over your pain (0–10), (complete – none) |
Outcomes analysis
Meana | Std Dev | Std Errorb | Patients Improvingc | N | |
---|---|---|---|---|---|
Starting Pain 1-9 | |||||
Panel A | −1.10 | 1.89 | 0.017 | 71.98 % | 11,927 |
Panel B | −1.21 | 2.01 | 0.018 | 72.58 % | 11,927 |
Starting Pain 7-9 | |||||
Panel C | −1.85 | 1.72 | 0.030 | 88.17 % | 4598 |
Panel D | −2.10 | 1.95 | 0.029 | 85.87 % | 4598 |