Rapid Improvement in Pain Management: The Veterans Health Administration and the Institute for Healthcare Improvement Collaborative

Abstract

Significant progress toward the target goals was reported during the Collaborative period. This improvement needs to be viewed in the context of a VHA system-wide effort to improve pain management. Data suggest that a program of team formation, goal identification, testing and adaptation of recommended system changes, sharing and feedback of process and outcome information can produce significant change in pain management in a major health care organization.

Adherence to Clinical Guidelines for Opioid Therapy for Chronic Pain in Patients with Substance Use Disorder

“…23 We chose NRS scores≥4 as indicating moderate to severe pain because it is consistent with prior research and aligns with VA clinical practice and policy regarding indication for further pain assessment. 24 To be included, patients must have been prescribed chronic opioid therapy, defined as 90 or more consecutive days. 10,25 We identified 28,556 potentially eligible patients.…”

Veterans reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system

“…Since the launching of the VHA pain strategy, major progress toward each of these stated goals has been documented [11,12]. Interestingly, to date, few epidemiological data have been published that specifically document the prevalence of pain and pain-related disability among veterans receiving care in the VHA [13].…”

Veterans Health Administrations pain research portfolio and publications

“…Members of the Coordinating Committee and others have published several articles that provide updates on the accomplishments related to the Strategy [21][22][23]. Results of the VHA/Institute for Healthcare Improvement project documented the ability to achieve rapid improvement in pain management during a 9-month period of intensive performance improvement efforts across 72 VA facilities [24]. Recently, Mularski et al examined the effects of the VHA "Pain as the 5th Vital Sign" Initiative [25].…”