BACKGROUND: Acute pain is present in up to 50% of patients seeking emergency medical services whereas chronic pain account for 10—16% of total ED visits in the US. and costs $8-24 billion per year. Chronic pain patients who frequently utilize Emergency Department services (e.g. high utilizers) often have a coexisting psychiatric diagnosis and are not well serviced by traditional care delivery paradigms. An intensive management program known as PARTNER (Pain Assessment Risk Treatments for Novel Effective Recovery) which employs dually trained psychiatric and pain management practitioners was developed for these complex patients to improve patient satisfaction and reduce the patients’ perceived need of emergency service. Herein, we describe the outcomes of the PARTNER Program.
METHODS: An Emergency Department (ED) “High Utilizer” chronic pain patient cohort was identified by a historic chart review, based on the criteria: six or more ED visits in the previous 6 months. Excluded were self-pay, patients, currently treated in the Duke Pain Center, currently using cocaine or heroin, pain secondary to a temporary medical condition, and any patient who didn't have at least 4 total visits to the ED of which at least 3 were for pain. Identified patients were entered into a patient tracking system (Duke Integrated Subject Cohort and Enrollment Research Network - DISCERN), and a social worker was notified automatically if/when the patient was registered in the ED. Once notified, the social worker approached the patient and offered referral to the PARTNER program within the Medical Pain Service (MPS). If the patient accepted the referral, an appointment was scheduled within 30 days. Follow up appointments were made at least monthly.
RESULTS: 148 patients qualified to participate in the initial PARTNER cohort. Nearly 80% of this cohort opted for referral to the MPS. In the first 3 months; 60 patients were contacted, 44 accepted referral, 39 were scheduled, 14 had completed the initial intake, 12 were scheduled and pending appointment, 10 had no-showed. Multiple psychosocial barriers were identified, including transportation, housing instability, previous drug abuse, untreated psychiatric comorbidities and insurance challenges. Current statistical analysis is in process.
DISCUSSION: An increased emphasis on population health has highlighted the importance for new models of care in the management of complex chronic pain patients. We have demonstrated in this pilot project that an intensive management program such as PARTNER can reduce ED utilization and healthcare cost, while improving patient satisfaction. We propose that similar intensive management models be studied in larger and more diverse cohorts to optimize resource management and patient satisfaction.
