Measuring pain as the 5th vital sign does not improve quality of pain management

Richard A. Mularski, Foy White-Chu, Devorah Overbay, Lois Miller, Steven M. Asch, Linda Ganzini

    Research output: Contribution to journalArticle

    191 Citations (Scopus)

    Abstract

    BACKGROUND: To improve pain management, the Veterans Health Administration launched the "Pain as the 5th Vital Sign" initiative in 1999, requiring a pain intensity rating (0 to 10) at all clinical encounters. OBJECTIVE: To measure the initiative's impact on the quality of pain management. DESIGN: We retrospectively reviewed medical records at a single medical center to compare providers' pain management before and after implementing the initiative and performed a subgroup analysis of patients reporting substantial pain (≥4) during a postimplementation visit. PARTICIPANTS: Unique patient visits selected from all 15 primary care providers of a general medicine outpatient clinic. MEASUREMENTS: We used 7 process indicators of quality pain management, based on appropriately evaluating and treating pain, to assess 300 randomly selected visits before and 300 visits after implementing the pain initiative. RESULTS: The quality of pain care was unchanged between visits before and after the pain initiative (P>.05 for all comparisons): subjective provider assessment (49.3% before, 48.7% after), pain exam (26.3%, 26.0%), orders to assess pain (11.7%, 8.3%), new analgesic (8.7%, 11.0%), change in existing analgesics (6.7%, 4.3%), other pain treatment (11.7%, 13.7%), or follow-up plans (10.0%, 8.7%). Patients (n=79) who reported substantial pain often did not receive recommended care: 22% had no attention to pain documented in the medical record, 27% had no further assessment documented, and 52% received no new therapy for pain at that visit. CONCLUSIONS: Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management.

    Original languageEnglish (US)
    Pages (from-to)607-612
    Number of pages6
    JournalJournal of General Internal Medicine
    Volume21
    Issue number6
    DOIs
    StatePublished - Jun 2006

    Fingerprint

    Vital Signs
    Pain Management
    Pain
    Medical Records
    Analgesics
    Veterans Health
    United States Department of Veterans Affairs
    Quality of Health Care
    Ambulatory Care Facilities

    Keywords

    • Outcome and process assessment (health care)
    • Pain
    • Pain measurement
    • Quality indicators
    • Quality of health care

    ASJC Scopus subject areas

    • Internal Medicine

    Cite this

    Measuring pain as the 5th vital sign does not improve quality of pain management. / Mularski, Richard A.; White-Chu, Foy; Overbay, Devorah; Miller, Lois; Asch, Steven M.; Ganzini, Linda.

    In: Journal of General Internal Medicine, Vol. 21, No. 6, 06.2006, p. 607-612.

    Research output: Contribution to journalArticle

    Mularski, Richard A. ; White-Chu, Foy ; Overbay, Devorah ; Miller, Lois ; Asch, Steven M. ; Ganzini, Linda. / Measuring pain as the 5th vital sign does not improve quality of pain management. In: Journal of General Internal Medicine. 2006 ; Vol. 21, No. 6. pp. 607-612.
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    title = "Measuring pain as the 5th vital sign does not improve quality of pain management",
    abstract = "BACKGROUND: To improve pain management, the Veterans Health Administration launched the {"}Pain as the 5th Vital Sign{"} initiative in 1999, requiring a pain intensity rating (0 to 10) at all clinical encounters. OBJECTIVE: To measure the initiative's impact on the quality of pain management. DESIGN: We retrospectively reviewed medical records at a single medical center to compare providers' pain management before and after implementing the initiative and performed a subgroup analysis of patients reporting substantial pain (≥4) during a postimplementation visit. PARTICIPANTS: Unique patient visits selected from all 15 primary care providers of a general medicine outpatient clinic. MEASUREMENTS: We used 7 process indicators of quality pain management, based on appropriately evaluating and treating pain, to assess 300 randomly selected visits before and 300 visits after implementing the pain initiative. RESULTS: The quality of pain care was unchanged between visits before and after the pain initiative (P>.05 for all comparisons): subjective provider assessment (49.3{\%} before, 48.7{\%} after), pain exam (26.3{\%}, 26.0{\%}), orders to assess pain (11.7{\%}, 8.3{\%}), new analgesic (8.7{\%}, 11.0{\%}), change in existing analgesics (6.7{\%}, 4.3{\%}), other pain treatment (11.7{\%}, 13.7{\%}), or follow-up plans (10.0{\%}, 8.7{\%}). Patients (n=79) who reported substantial pain often did not receive recommended care: 22{\%} had no attention to pain documented in the medical record, 27{\%} had no further assessment documented, and 52{\%} received no new therapy for pain at that visit. CONCLUSIONS: Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management.",
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