Pain management in hospitals is improving across the board, but not as much as might be hoped, according to the results of a study pending publication. The study found a statistically significant increase in patient satisfaction with pain care in government-owned, for-profit and nonprofit hospitals between October 2006 and March 2012, but also found that this increase did not keep pace with other improvements, such as patient satisfaction with overall care.
The study examined data collected from more than 1,800 hospitals by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, created by the Centers for Medicare & Medicaid Services (CMS). The survey asks patients 27 questions about their experiences while hospitalized. The 2012 survey results indicated that, on average, hospitals were able to “always” control a patient’s pain 70% of the time, an increase of 2.54% from 2008, when the results were first published. By comparison, the other dimensions measured by the HCAHPS survey, including the quality of communication with doctors and nurses and staff responsiveness, improved by 4.49%.
“Essentially, the data show that there’s only a minor uptick in the amount of patients who had significant improvements of their pain control during their hospitalization,” said Anita Gupta, DO, PharmD, principal investigator of the study and vice chair of the Division of Pain Medicine and Regional Anesthesiology at Drexel University College of Medicine, in Philadelphia. “With the increasing amount of pain physicians who are being trained in the treatment of acute and chronic pain, and in addition, the increasing advocacy related to the treatment of pain and chronic pain, the expectation would be to see more significant improvement with patient satisfaction.
“Overall, a majority of patients in the hospital setting are still moderately satisfied with their pain control, but we can certainly do better,” Dr. Gupta added.
These results extend a 2009 study by Dr. Gupta and her colleagues published in the Journal of Pain Research (2009;2:157-164), that examined the first round of data from the HCAHPS survey. The relatively modest level of improvement in patient satisfaction with pain care may indicate a need for increased initiatives for advocacy, research and education in the management of both acute and chronic pain, Dr. Gupta said.
“I intend to continue to study the HCAHPS data over the next several years to see if improvements are being made,” she said. “Unless more stakeholders make significant initiatives and commitments in the treatment of pain, there likely will be minimal change in how patients perceive their pain during a hospital stay.”
The study represents a good first step in helping anesthesiologists assess the quality of care that they provide, said John Dombrowski, MD, medical director of the Anesthesiologist Assistant Program and clinical assistant professor at Case Western Reserve University’s campus in Washington, D.C. However, he added that the survey data, although valuable, are inherently subjective, and objective measures also should be taken into account when assessing the quality of physicians’ work.
“Some patients will always say that they’re in pain because they want to get a certain feeling. And that’s just the way some patients can be in certain settings,” Dr. Dombrowski said. “We need to look at other measurements, like their blood pressure and their heart rate. If their blood pressure and heart rate are normal, they can’t be in much pain because these would be elevated.”
Moreover, Dr. Dombrowski said, although the data provide valuable information to help anesthesiologists to improve their work, the HCAHPS survey also represents an attempt on the part of the government to cut costs.
“In the world of government, nothing is about quality,” he said. “That’s the fig leaf they use. Everyone wants quality, including anesthesiologists—we all want to do good work. But for the government, it’s about cost containment or cost cutting.
“That’s important right now, because the government is looking in terms of value-added services,” he continued. “If I’m paying you this money, you have to prove to me that you earned it in some way. That being said, we at the ASA [American Society of Anesthesiologists] are trying to find quality measures or tools that we can use, and this is a helpful tool.”