1. Pain Management In The Patient-Centered Primary Care Home
Kevin Cuccaro, D.O.
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

2. Pilot Summary January 2016-December 2017 $298,855
The goal of this pilot was to increase primary care provider's knowledge, treatment of, and confidence in treating chronic pain. The intervention was a unique educational and interactive program designed by a fellowship trained chronic pain specialist specifically for primary care providers. Ultimately, the goal was to improve patient outcomes, reduce patient harm, and improve utilization of healthcare resources by changing clinician behavior.
13 PCPCHs received direct assessment, training and on-going support.
59+ clinicians trained
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

3. Key Outcomes (All Goals Met) PABS-PT (Δ pre-/post-)
Biopsychosocial Beliefs
Biomechanical Beliefs
 FABQ (Δ pre-/post-)
 Clinician Pain Self-Efficacy (Δ pre-/post-)
 Clinician Treatment Outcome Expectations (Δ pre-/post-)
 Radiography for Nonspecific Low Back Pain*
 Opioid Prescriptions*
(All Goals Met)
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

4. Key Outcomes
DST PILOT CLOSEOUT PRESENTATION INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

5. Key Outcomes DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

6. Key Outcomes DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

7. Key Outcomes DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

8. Key Outcomes DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

9. Successes Belief Change  Behavioral Change
Regional-Wide Culture Change (small but expanding)
‘Pain-Centric’ vs. ‘Opioid-Centric’
State-Wide Implications (CIF, OPMC, OHA HERC Chronic Pain Task Force)
Improving the Pain Referral Pathway in the Patient-Centered Primary Care Home Pilot (next)
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

10. Learning Experiences
Did you make any changes because you learned how to do something better?
Did something not work so you adjusted, what/how did you adjust?
What were the key factors that helped the pilot through a difficult period?
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

11. Partnerships & Collaboration
Multi-System involvement.
Painwise/MVPA
Partnerships & Collaboration Weaknesses (Remaining Challenges)
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

12. Remaining Challenges
Maintaining & Expanding Consistent Science-Based Messaging
Lack of Patient Resources (& ‘Default’ Bx)
Clinician Turnover
Data Collection & Analysis
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

13. Post Pilot Sustainability
Will your pilot be sustained post pilot? Maybe
Replicability? Yes, but…
Scalability? Yes, but…
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

14. Discussion IPRP Next… DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

15. Improving The Pain Referral Pathway In the PCPCH
Kevin Cuccaro, D.O.
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

16. Pilot Summary July 2016-June 2017 $163,955
This pilot’s goal was to improve the care of pain patients referred to rehabilitative therapy by their primary care providers by improving rehabilitation specialists understanding of (& confidence in treating) pain. This educational intervention was delivered to clinicians in the hope that by improving their understanding of pain it would result in changing how they understand, approach, and treat pain in their patients.
12 Clinical Groups
93+ Clinicians
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

17. Key Outcomes PABS-PT (Δ pre-/post-) Biopsychosocial Beliefs
Biomechanical Beliefs
 FABQ (Δ pre-/post-)
Tri-County Participation
( Clinician Pain Knowledge Δ pre-/post-)
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

18. Key Outcomes DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

19. Successes Strong adoption in certain regions
Lebanon = ‘Pain Mecca’
‘Empowering’ Pain Program (MMAPS)
Mid-Valley Pain Alliance/Community Education
Existing Pain Program Re-Vamped (ACT Beyond Pain)
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

20. Learning Experiences
Did you make any changes because you learned how to do something better?
Did something not work so you adjusted, what/how did you adjust?
What were the key factors that helped the pilot through a difficult period?
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

21. Partnerships & Collaboration
New partnerships or linkages because of the pilot:
Mid-Valley Pain Alliance/Community Education
Existing Pain Program Re-Vamped (ACT Beyond Pain)
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

22. Remaining Challenges
Variability in pain knowledge and practice patterns between different clinics and providers (including providers in same clinic).
Robust misconceptions regarding pain & pain treatments.
Maintaining & Expanding Consistent Science-Based Messaging
(Hopefully, not ‘ego’ but…)
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

23. Post Pilot Sustainability
Will your pilot be sustained post pilot?
Yes but smaller, more ‘region’ specific
Replicability? Yes, but…
Scalability? Yes, but…
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION

24. Discussion-Summaries
PMP
IPRP
PABS-PT (Δ pre-/post-)
Biopsychosocial Beliefs
Biomechanical Beliefs
 FABQ (Δ pre-/post-)
 Clinician Pain Self-Efficacy (Δ pre- /post-)
 Clinician Treatment Outcome Expectations (Δ pre-/post-)
 Radiography for Nonspecific Low Back Pain
 Opioid Prescriptions
PABS-PT (Δ pre-/post-)
Biopsychosocial Beliefs
Biomechanical Beliefs
 FABQ (Δ pre-/post-)
Tri-County Participation
( Clinician Pain Knowledge Δ pre-/post-)
DST PILOT CLOSEOUT PRESENTATION
INTERCOMMUNITY HEALTH NETWORK COORDINATED CARE ORGANIZATION