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Patient Outcomes in Pain Management Enterprise One Pain Management Service Report for period ending 31 December 2014

About the electronic Persistent Pain Outcomes Collaboration (ePPOC) ePPOC is a program which aims to help improve services and outcomes for patients experiencing chronic pain through benchmarking of care and treatment. ePPOC is an initiative of the Faculty of Pain Medicine, and has been further developed in recent years by the Faculty, the Australian Pain Society and the wider pain sector. ePPOC involves the collection of a standard set of data items and assessment tools by specialist pain services throughout Australia and New Zealand to measure outcomes for their patients as a result of treatment. This information will be used to develop a national benchmarking system for the pain sector, which will lead to better outcomes and best practice interventions for patients in chronic pain. The information will also enable development of a coordinated approach to research into the management of pain in Australasia. Participation in ePPOC is voluntary and aims to assist pain management service providers to improve practice. epiCentre (the software purpose-built for ePPOC) helps to achieve this by;

• providing clinicians with an approach to systematically assess individual patient experiences • defining a common clinical language to streamline communication between pain management

providers • facilitating the routine collection of national pain management data to drive quality improvement

through reporting and benchmarking

The ePPOC dataset includes the following assessment tools: Brief Pain Inventory (BPI) i, Depression, Anxiety and Stress Scale (DASS) ii, Pain Self-Efficacy Questionnaire (PSEQ) iii and Pain Catastrophising Scale (PCS) iv. The ePPOC team is located within the Australian Health Services Research Institute at the University of Wollongong. If you would like more information about ePPOC please visit our website at http://ahsri.uow.edu/eppoc/index.html, email us at [email protected] or phone (02) 4221 4411.

This document provides an example of the information provided to services in the six-monthly ePPOC reports. ‘Enterprise One’ is a fictitious pain management service whose data consists of records that have been randomly generated from actual participating services.

http://ahsri.uow.edu/eppoc/index.html

mailto:[email protected]

Patient Outcomes in Pain Management, Report 2 (for data submitted to 31 December 2014) i

Contents

Introduction .......................................................................................................................... 1

Section 1 – Summary of data and outcomes included in this report ......................................... 2

1.1 Data summary ........................................................................................................... 2 1.2 Patient reported outcome measure summary ......................................................... 3

Section 2 – Outcome measures in detail ................................................................................. 5

2.1 Outcome measure 1 – Assessment tools .................................................................. 5 2.1.1 Change from referral to post-discharge follow-up ................................................... 7 2.1.2 Change from referral to episode end ..................................................................... 11 2.1.3 Change from pathway start to pathway end .......................................................... 17 2.2 Outcome measure 2 – Ability to work .................................................................... 23 2.3 Outcome measure 3 – Health service use .............................................................. 25 2.4 Outcome measure 4 – Pain frequency ................................................................... 26 2.5 Outcome measure 5 – Time from referral to first contact ..................................... 27 2.6 Outcome measure 6 – Medication use ................................................................... 28

Section 3 - Descriptive analysis............................................................................................. 29

3.1 Profile of pain management patients ..................................................................... 29 3.2 Profile of pain management episodes .................................................................... 30 3.3 Profile of pain management pathways ................................................................... 36

References .......................................................................................................................... 38

Appendix A – Item completion ............................................................................................. 39

Appendix B – Relationship between levels of ePPOC data ..................................................... 41

Acknowledgements ............................................................................................................. 42

Patient Outcomes in Pain Management, Report 2 (for data submitted to 31 December 2014) ii

List of Tables Table 1 Number and percentage of patients, episodes and pathways 3 Table 2 Average outcome measure scores 4 Table 3 DASS severity ratings 6 Table 4 Assessment tools – Average change from referral to post-discharge follow-up 7 Table 5 Assessment tools – Change from referral to episode end 11 Table 6 Assessment tools – Change from pathway start to pathway end 17 Table 7 Assessment tools – Pathway start score and change from pathway start to end by pathway type 22 Table 8 Work status 23 Table 9 Pain affects work or study 23 Table 10 Health service use (median number of times used in the last 3 months due to pain) 25 Table 11 Pain frequency item (percentage of patients in each group) 26 Table 12 Time from referral to first contact 27 Table 13 Medication use 28 Table 14 Sex 29 Table 15 Indigenous status 29 Table 16 Country of birth 30 Table 17 Interpreter required 30 Table 18 Communication assistance 30 Table 19 Age at referral by sex 30 Table 20 Age group at referral by sex - distribution 31 Table 21 Compensation case 31 Table 22 Main pain site at referral 31 Table 23 Number of pain sites at referral 32 Table 24 Referral source 32 Table 25 How main pain began (precipitating event) 32 Table 26 Cancer pain 33 Table 27 Comorbidities 33 Table 28 Pain duration 33 Table 29 Episode start mode 34 Table 30 Episode end mode 34 Table 31 Length of episode - summary 34 Table 32 Length of episode - distribution 34 Table 33 Number of pathways per episode 35 Table 34 Service intensity - time per episode (for completed episodes) 35 Table 35 Number of pathways by pathway type 36 Table 36 Average pathway length (in days) by pathway type 36 Table 37 Service intensity - time per pathway (for completed pathways) 37 Table 38 Item completion (percent complete) - patient level 39 Table 39 Item completion (percent complete) - episode level 39 Table 40 Item completion – assessment tools 40 Table 41 Questionnaire response (percent returned) 40

Patient Outcomes in Pain Management, Report 2 (for data submitted to 31 December 2014) iii

List of Figures Figure 1 Assessment tools - Change from referral to post-discharge follow-up ........................................... 8 Figure 2 Assessment tools - Change from referral to episode end .............................................................. 12 Figure 3 Assessment tools - Change from pathway start to pathway end .................................................. 18 Figure 4 Pain affects number of hours able to work or study ..................................................................... 24 Figure 5 Pain affects type of work ............................................................................................................... 24 Figure 6 Health service use from referral to follow-up................................................................................ 25 Figure 7 Pain frequency - Change through episode ..................................................................................... 26 Figure 8 Median number of days from referral to first contact (episode start) .......................................... 27

Patient Outcomes in Pain Management, Report 2 (for data submitted to 31 December 2014) 1

Introduction ePPOC aims to assist services to improve the quality of the pain management they provide through the analysis and benchmarking of patient outcomes. In this report, data submitted to 31 December 2014 are summarised to enable participating services to assess their performance and compare this with outcomes achieved by other services. This report is broken into three sections:

• Section 1 provides a summary of the data and outcomes included in this report. • Section 2 presents a more detailed analysis of the outcome measures. • Section 3 provides descriptive analysis at each of the patient, episode and pathway data levels.

In each of the three sections, data and analysis for Enterprise One Pain Management Service is presented alongside those for all services for comparative purposes. The figures reflect all pain management services who submitted data to 31 December 2014. The data from 21 adult services are included in this report. The outcome measures included in this report were agreed upon by representatives of the pain sector. Although no benchmarks for these outcomes have been included in this report, these will be incorporated in future reports when the volume of data is large enough to enable their creation. The process of reporting and benchmarking against other services provides opportunities to understand the services that are provided to patients, the outcomes patients experience and also to generate research opportunities focused on demonstrating variations in practice and outcomes.

Please note that some tables throughout this report may be incomplete. This is because some items may not be applicable to a particular service or it may be due to data quality issues. Please use the following key when interpreting the tables:

na The item is not applicable u The item was unavailable/unable to be calculated due to missing or invalid data.

Data in the tables in this report are determined by a data scoping method. This defines what data are included and can vary from table to table. Users should take note of the data scoping method described for each table.


Section 1 – Summary of data and outcomes included in this report

1.1 Data summary Data were received from a total of 21 services who provided information on 6361 patients. In total, these patients had 3418 episodes of care and 2422 pain management pathways. The services providing data for this report are:

• Caulfield Pain Management and Research Centre • Greenwich Hospital Pain Management Service • Goulburn Valley Chronic Pain Service • Hunter Integrated Pain Service • Lismore Hospital Multidisciplinary Pain Management Clinic • Liverpool Hospital Chronic Pain Service • Melbourne Health Chronic Pain Clinic • Nepean Hospital Pain Management Unit • Orange Base Hospital Chronic Pain Clinic • Peninsula Health Chronic Pain Management Service • Illawarra-Shoalhaven Chronic Pain Service • Port Macquarie Chronic Pain Service • Prince of Wales Pain Management Department • Royal North Shore Hospital Pain Service • Royal Prince Alfred Pain Management Service • Sir Charles Gairdner Hospital • St George Pain Management Unit • St Vincents Hospital Pain Clinic • Barbara Walker Centre for Pain Management • Tamworth Integrated Pain Service • Western Health Pain Management

The following table includes data for all patients, episodes, pathways and questionnaires that were active in the reporting period.


Table 1 Number and percentage of patients, episodes and pathways Enterprise One All Services Number of patients 763 6361 Number of episodes 623 3418 Number of pathways 619 2422 Number of questionnaires returned 852 6267

Average number of pathways per episode* 1.1 1.1

Number of group pathways 468 866 Number of individual pathways 102 1142 Number of concurrent pathways 47 242 Number of one-off pathways 2 172

Response rate to questionnaires (%)† 84.4 82.8 * Average number of pathways per episode is only calculated for closed episodes that ended within the reporting period. † The number of questionnaires completed as a percentage of the number sent

The relationship between the different levels of information collected under ePPOC (patient, episode, pathway, service event and questionnaires) is shown in Appendix B.

1.2 Patient reported outcome measure summary Patients’ average scores across the assessment tools for all questionnaires received in the reporting period are shown in Table 2. Enterprise One reported on:

• 715 referral questionnaires • 75 questionnaires at the start of a pathway in an episode • 39 questionnaires at the end of a pathway in an episode, and • 0 post-discharge follow-up questionnaires.

In comparison, all services reported;

• 5159 referral questionnaires • 410 questionnaires at the start of a pathway in an episode • 170 questionnaires at the end of a pathway in an episode, and • 50 post-discharge follow-up questionnaires.

Patients in each of the four time points are not necessarily the same. Therefore follow-up and pathway end scores are not necessarily representative of patients who completed earlier ratings. This comment applies equally to the remaining tables in this report unless otherwise noted.

Non-valid scales and subscales have been excluded from this table. See Appendix A for more information on the volume and proportion of missing responses.

Further information on assessment tools and subscales can be found in Section 2 of this report.


Table 2 Average outcome measure scores

Outcome measure†

Enterprise One All Services Referral Pathway

start Pathway

end Follow-up Referral Pathway

start Pathway

end Follow-up

n=715 n=75 n=39 n=0 n=5159 n=410 n=170 n=50 BPI

Severity§ 6.4 5.7 6.1 . 6.4 5.7 5.6 5.0 Interference 7.1 6.5 6.5 . 7.1 6.3 5.8 4.5

DASS Depression 20.4 17.8 18.5 . 20.3 18.2 15.7 11.0 Anxiety 13.7 12.3 13.1 . 14.2 12.7 11.8 9.5 Stress 20.4 18.6 20.1 . 21.0 19.9 18.6 13.4

PCS Total 29.7 24.9 22.5 . 30.0 25.1 20.2 17.4

PSEQ* Total 20.7 23.3 24.9 . 20.6 24.7 28.3 34.8

§ The severity score is an average of the four severity items * Note: For the PSEQ assessment tool, a positive movement in score is an improvement in how patients are able to perform activities despite the pain. † See Appendix A for information on item completion.


Section 2 – Outcome measures in detail Four standardised assessment tools have been chosen to measure patient outcomes (see below for more information). In addition, pain frequency, the patients’ ability to work, health service use and time from referral to first contact have also been included as outcomes.

Records must have valid start and end scores for the outcome measure to be included in the tables below – therefore records where the response is not stated have been excluded from the calculation of percentages in this section. See Appendix A for information on the proportion of missing responses.

2.1 Outcome measure 1 – Assessment tools The assessment tools used in this section are:

• Brief Pain Inventory (BPI) • Depression, Anxiety, Stress Scale (DASS) • Pain Catastrophising Scale (PCS) • Pain Self-Efficacy Questionnaire (PSEQ).

Each of these assessment tools are briefly described below. Brief Pain Inventory The BPI items used in the ePPOC dataset measure the severity of pain and the degree to which the pain interferes with common activities of daily living.

Pain severity questions are rated on a scale of 0 to 10, where 0 = ‘No pain’ and 10 = ‘Pain as bad as you can imagine’, with patients asked to rate their average, worst and least pain over the last week, and their pain right now.

Severity bands for these items are: • 0-4 = mild pain • 5-6 = moderate pain • 7-10 = severe pain

The IMMPACT group’s recommendations for assessing clinical significance for 0-10 numeric pain scales are that a change of:

≥ 10% represents minimally important change ≥ 30% represents moderate clinically important change ≥ 50% represents substantial clinically important change v

The interference questions are rated on a scale of 0 to 10, where 0 = ‘Does not interfere’ and 10 = ‘Completely interferes’. The interference subscale is an average of the seven interference questions. At least 4 of 7 questions must be completed for this subscale to be valid. The IMMPACT recommendation for assessment of clinically significant change on the BPI interference scale is a change of 1 point over the average of the 7 items v Depression Anxiety Stress Scales The DASS measures the negative emotional states of depression, anxiety and stress. Due to the large number of questions in the full DASS (42 questions), the DASS21 is administered. This comprises 21 questions which are rated on a scale of 0 to 3, where 0 = ‘did not apply to me at all’, 1 = ‘applied to me to some degree, or some of the time’, 2 = ‘applied to me to a considerable degree, or a good part of the


time’, or 3 = ‘applied to me very much, or most of the time’. Scores are multiplied by 2 to enable comparison with the full-scale DASS42 for which norms exist.

For each subscale (Depression, Anxiety and Stress), the 7 items are summed and then multiplied by 2. The test developers suggest that at least 6 of 7 items should be complete for each subscale to be considered valid. The following table shows the range of scores associated with severity categories for each subscale. Table 3 DASS severity ratings

Depression Anxiety Stress Normal 0-9 0-7 0-14 Mild 10-13 8-9 15-18 Moderate 14-20 10-14 19-25 Severe 21-27 15-19 26-33 Extremely Severe 28+ 20+ 34+ Clinical significance on each of the DASS subscales requires a change of 5 or more points coupled with a move to a different severity category Pain Catastrophising Scale The PCS measures a patient’s thoughts and feelings related to their pain. This includes three subscales measuring the dimensions of Rumination, Magnification and Helplessness. The PCS comprises 13 questions (Rumination – 4 items, Magnification – 3 items, Helplessness – 6 items) which are rated on a scale of 0 to 4, where 0 = ‘not at all’, 1 = ‘to a slight degree’, 2 = ‘to a moderate degree’, 3 = ‘to a great degree’ and 4 = ‘all the time’. For each subscale, all items must be completed to be valid. For the total to be valid, at least 12 of 13 items must be completed.

Severity bands for the PCS are: • <20 = mild • 20 to 30 = high • >30 = severe

Clinically significant change requires a change in score of 6 or more points, combined with movement to a different severity category vii. Pain Self-Efficacy Questionnaire The PSEQ measures how confident a patient is that he or she can do a range of activities despite their pain. The PSEQ Total is a sum of scores from 10 questions which are rated on a scale from 0 = ‘Not confident at all’ to 6 = ‘Completely confident’. At least 9 of 10 items must be complete for the PSEQ Total to be valid. Increases in score represent an improvement in self-efficacy.

Severity bands for the PSEQ are: • <20 = severe • 20 to 30 = moderate • 31 to 40 = mild • >40 = minimal impairment

Clinically significant change requires a change in score of 7 or more points, combined with movement to a different severity category viii .


2.1.1 Change from referral to post-discharge follow-up This section describes change occurring from initial referral to a pain management service to a point three months after the patient is discharged. This allows evaluation of the changes made as a result of the treatment received, and the longevity of those changes.

The average change in the outcome measures for patients who completed both a referral and post-discharge follow-up questionnaire where the follow-up questionnaire was returned within the reporting period is shown in Table 4. Enterprise One Pain Management Service received referral and post-discharge follow-up questionnaires from 0 patients. Although these patients returned both referral and post-discharge follow-up questionnaires, some of the standardised assessment tools may not be validly completed. Please see Section 2.1 for information on valid responses for each outcome measure. Table 4 includes the number and percentage of validly completed outcomes for each of the assessment tools, calculated by dividing the number of valid outcomes by the number of patients (as described above).

Table 4 Assessment tools – Average change from referral to post-discharge follow-up

Assessment tool†

Enterprise One n=

All Services n=48

Score at referral

Average change

Valid outcome (number)

Valid outcome

(%)

Score at referral

Average change

Valid outcome (number)

Valid outcome

(%) BPI

Worst pain 7.4 -0.9 46 95.8 Least pain 4.0 -0.7 45 93.8 Average pain 5.9 -1.1 47 97.9 Pain now 5.2 -0.4 47 97.9 Interference 5.8 -1.3 47 97.9

DASS Depression 14.8 -3.9 46 95.8 Anxiety 11.5 -2.7 46 95.8 Stress 17.3 -4.5 46 95.8

PCS Rumination 7.4 -1.7 43 89.6 Magnification 4.2 -0.4 41 85.4 Helplessness 10.8 -2.5 38 79.2 Total 22.1 -5.0 43 89.6

PSEQ* Total 26.2 8.2 46 95.8

* Note: For the PSEQ assessment tool, a positive movement in score is an improvement in how patients are able to perform activities despite the pain. † See Appendix A for information on item completion.


Figure 1 Assessment tools - Change from referral to post-discharge follow-up BPI – Average Pain BPI – Worst Pain

As noted above in Section 2.1, a change of ≥ 10% represents minimally important change, ≥ 30% moderate clinically important change and ≥ 50% represents substantial clinically important change. BPI – Interference

The IMMPACT recommendation for assessment of clinically significant change on the BPI interference scale is a change of 1 point over the average of the 7 items. .% of Enterprise One patients saw improvement of 1 or more points, compared to 53.2% for all services. Scores for .% of Enterprise One patients increased (i.e. deteriorated) by one or more points (all services = 14.9%) and .% did not change (all services = 31.9%).


DASS – Depression

According to the criteria outlined in Section 2.1, .% of Enterprise One patients made clinically significant gains on the DASS depression subscale, .% showed no change and .% deteriorated. In comparison, 28.3% of patients at all services improved, 58.7% did not change and 13% deteriorated.

DASS – Anxiety

.% of Enterprise One patients made clinically significant gains on the DASS anxiety subscale, .% showed no change and .% deteriorated. In comparison, 28.3% of patients at all services improved, 63% did not change and 8.7% deteriorated.


DASS – Stress

.% of Enterprise One patients made clinically significant gains on the DASS stress subscale, .% showed no change and .% deteriorated. In comparison, 32.6% of patients at all services improved, 58.7% did not change and 8.7% deteriorated.

PCS - Total

Section 2.1 guidelines for assessing clinically significant change on the PCS indicate that .% of Enterprise One patients showed significant improvement, .% did not change and .% deteriorated. In comparison, 27.9% of patients at all services improved, 62.8% did not change and 9.3% deteriorated.


PSEQ – Total

According to the criteria outlined in Section 2.1, .% of Enterprise One patients showed clinically significant improvement on the PSEQ, .% did not change and .% deteriorated. In comparison, 43.5% of patients at all services improved, 47.8% did not change and 8.7% deteriorated.


2.1.2 Change from referral to episode end Measurement of change from referral to the end of the episode (end of the final pathway) allows evaluation of the changes made for those patients who fail to complete the three month post-discharge follow-up. Instances where an episode has ended but the 3 month post-discharge follow-up has not yet occurred will also be included in this outcome measure.

Enterprise One Pain Management Service received referral and episode end questionnaires for 16 episodes. Table 5 shows the average change for patients completing the assessment tools at referral and episode end. Responses have only been included if the same patient returned both the referral and episode end questionnaires.

Table 5 Assessment tools – Change from referral to episode end

Assessment tool†

Enterprise One n=16

All Services n=48

Score at referral

Average change

Valid outcomes (number)

Valid outcomes

(%)

Score at referral

Average change


Valid outcomes

(%) BPI

Worst pain 7.9 -0.7 16 100.0 7.9 -0.5 46 95.8 Least pain 4.5 -0.1 16 100.0 4.2 -0.7 45 93.8 Average pain 6.3 -0.5 16 100.0 6.2 -0.7 45 93.8 Pain now 6.3 -0.3 16 100.0 5.9 -0.4 46 95.8 Interference 6.8 -0.9 16 100.0 6.5 -1.1 45 93.8

DASS Depression 18.5 -4.7 12 75.0 16.4 -4.1 43 89.6 Anxiety 13.7 -3.2 12 75.0 11.3 -0.3 43 89.6 Stress 18.2 -2.8 12 75.0 18.0 -1.4 43 89.6

PCS Rumination 8.7 -2.2 9 56.3 8.0 -2.1 36 75.0 Magnification 5.1 -0.8 11 68.8 4.5 -1.0 38 79.2 Helplessness 12.3 -2.8 12 75.0 11.8 -3.1 39 81.3 Total 26.1 -5.7 11 68.8 24.4 -6.1 38 79.2

PSEQ* Total 18.2 8.3 16 100.0 22.4 7.3 45 93.8



Figure 2 Assessment tools - Change from referral to episode end BPI – Average Pain BPI – Worst Pain


The IMMPACT recommendation for assessment of clinically significant change on the BPI interference scale is a change of 1 point over the average of the 7 items. 37.5% of Enterprise One patients saw improvement of 1 or more points, compared to 46.7% for all services. Scores for 12.5% of Enterprise One patients increased (i.e. deteriorated) by one or more points (all services = 8.9%) and 50% did not change (all services = 44.4%).


DASS - Depression

According to the criteria outlined in Section 2.1, 33.3% of Enterprise One patients made clinically significant gains on the DASS depression subscale, 50% showed no change and 16.7% deteriorated. In comparison, 39.5% of patients at all services improved, 41.9% did not change and 18.6% deteriorated.

DASS - Anxiety

25% of Enterprise One patients made clinically significant gains on the DASS anxiety subscale, 58.3% showed no change and 16.7% deteriorated. In comparison, 20.9% of patients at all services improved, 55.8% did not change and 23.3% deteriorated.


DASS - Stress

25% of Enterprise One patients made clinically significant gains on the DASS stress subscale, 58.3% showed no change and 16.7% deteriorated. In comparison, 27.9% of patients at all services improved, 53.5% did not change and 18.6% deteriorated.

PCS - Total

Section 2.1 guidelines for assessing clinically significant change on the PCS indicate that 9.1% of Enterprise One patients showed significant improvement, 90.9% did not change and 0% deteriorated. In comparison, 26.3% of patients at all services improved, 71.1% did not change and 2.6% deteriorated.


PSEQ - Total

According to the criteria outlined in Section 2.1, 43.8% of Enterprise One patients showed clinically significant improvement on the PSEQ, 50% did not change and 6.3% deteriorated. In comparison, 37.8% of patients at all services improved, 55.6% did not change and 6.7% deteriorated.


2.1.3 Change from pathway start to pathway end In addition to considering the effect of the entire episode of care, the outcomes for pathways within an episode are also of interest. Enterprise One Pain Management Service received pathway start and end questionnaires for 19 pathways.

The average change for patients completing the assessment tools at pathway start and pathway end is shown in Table 6.

Table 6 Assessment tools – Change from pathway start to pathway end

Assessment tool†

Enterprise One n=19

All Services n=126

Score at pathway

start

Average change


Valid outcomes

(%)

Score at pathway

start

Average change


Valid outcomes

(%) BPI

Worst pain 6.9 0.1 19 100.0 8.0 -0.5 121 96.0 Least pain 4.2 0.3 19 100.0 4.5 -0.7 119 94.4 Average pain 5.7 -0.2 19 100.0 6.2 -0.6 121 96.0 Pain now 5.6 0.2 19 100.0 6.1 -0.6 120 95.2 Interference 6.5 -0.8 19 100.0 7.0 -1.3 121 96.0

DASS Depression 14.9 -1.2 18 94.7 19.2 -3.9 117 92.9 Anxiety 10.0 -0.4 18 94.7 13.5 -1.8 119 94.4 Stress 15.4 1.2 18 94.7 20.2 -1.9 118 93.7

PCS Rumination 8.0 -1.6 14 73.7 8.8 -2.3 106 84.1 Magnification 4.4 -0.8 17 89.5 5.1 -1.4 109 86.5 Helplessness 10.7 -2.5 17 89.5 13.1 -3.5 108 85.7 Total 23.3 -5.0 17 89.5 26.9 -7.1 112 88.9

PSEQ* Total 24.3 6.1 19 100.0 20.6 7.1 119 94.4



Figure 3 Assessment tools - Change from pathway start to pathway end

BPI – Average Pain BPI – Worst Pain


The IMMPACT recommendation for assessment of clinically significant change on the BPI interference scale is a change of 1 point over the average of the 7 items. 47.4% of Enterprise One patients saw improvement of 1 or more points, compared to 53.8% for all services. Scores for 5.3% of Enterprise One patients increased (i.e. deteriorated) by one or more points (all services = 7.6%) and 47.4% did not change (all services = 38.7%).


DASS - Depression

According to the criteria outlined in Section 2.1, 27.8% of Enterprise One patients made clinically significant gains on the DASS depression subscale, 50% showed no change and 22.2% deteriorated. In comparison, 38.3% of patients at all services improved, 51.3% did not change and 10.4% deteriorated.

DASS – Anxiety

16.7% of Enterprise One patients made clinically significant gains on the DASS anxiety subscale, 66.7% showed no change and 16.7% deteriorated. In comparison, 28.8% of patients at all services improved, 53.4% did not change and 17.8% deteriorated.


DASS - Stress

5.6% of Enterprise One patients made clinically significant gains on the DASS stress subscale, 61.1% showed no change and 33.3% deteriorated. In comparison, 28.8% of patients at all services improved, 56.8% did not change and 14.4% deteriorated.

PCS - Total

Section 2.1 guidelines for assessing clinically significant change on the PCS indicate that 23.5% of Enterprise One patients showed significant improvement, 70.6% did not change and 5.9% deteriorated. In comparison, 27.6% of patients at all services improved, 62.9% did not change and 9.5% deteriorated.


PSEQ - Total

According to the criteria outlined in Section 2.1, 36.8% of Enterprise One patients showed clinically significant improvement on the PSEQ, 52.6% did not change and 10.5% deteriorated. In comparison, 33.6% of patients at all services improved, 58.8% did not change and 7.6% deteriorated.


The start and change scores for the assessment tools by pathway type is shown in Table 7 – this allows for comparison between outcomes for different types of pathways. Data are only included where the same patient responded to questions in both the pathway start and end questionnaires.

Table 7 Assessment tools – Pathway start score and change from pathway start to end by pathway type

Assessment tool†

Enterprise One All Services Group Individual Concurrent One-off Group Individual Concurrent One-off n=14 n=. n=5 n=. n=104 n=8 n=13 n=1

Start Change Start Change Start Change Start Change Start Change Start Change Start Change Start Change BPI

Worst pain 6.6 0.0 . . 8.0 0.2 . . 8.0 -0.4 7.5 0.2 8.3 -1.1 7.0 1.0 Least pain 3.9 -0.2 . . 5.0 1.6 . . 4.5 -0.8 4.7 -0.2 4.4 -0.2 6.0 -1.0 Average pain 5.4 -0.6 . . 6.6 0.8 . . 6.2 -0.6 5.8 0.2 6.2 -0.5 7.0 -1.0 Pain now 5.3 -0.2 . . 6.4 1.2 . . 6.1 -0.6 6.3 -0.2 6.0 -0.4 7.0 -1.0 Interference 5.9 -0.9 . . 8.3 -0.5 . . 7.1 -1.4 6.3 0.4 7.2 -1.0 5.3 0.4

DASS Depression 14.1 -0.1 . . 17.5 -5.0 . . 18.9 -4.1 26.5 -6.0 20.7 -1.7 8.0 0.0 Anxiety 8.7 1.1 . . 14.5 -6.0 . . 12.7 -2.0 19.2 -2.8 18.2 -0.8 0.0 6.0 Stress 14.3 3.4 . . 19.5 -6.5 . . 19.9 -2.0 16.7 1.3 23.8 -1.5 12.0 0.0

PCS Rumination 8.7 -2.1 . . 5.3 0.3 . . 8.9 -2.4 9.0 -3.0 8.8 -1.8 5.0 -1.0 Magnification 4.4 -0.8 . . 4.3 -0.8 . . 5.1 -1.4 4.5 -3.5 5.6 -0.8 0.0 1.0 Helplessness 10.9 -2.4 . . 10.0 -3.0 . . 13.0 -3.5 13.5 -4.3 13.2 -3.6 13.0 -4.0 Total 23.9 -5.5 . . 21.3 -3.5 . . 26.9 -7.1 27.0 -10.8 27.8 -6.1 18.0 -4.0

PSEQ* Total 24.4 9.7 . . 24.0 -4.2 . . 20.7 8.0 12.2 2.3 22.8 3.4 35.0 -4.0



2.2 Outcome measure 2 – Ability to work The work status of patients who returned questionnaires in the reporting period is shown in Table 8.

Table 8 Work status

Work status (percentage*)


start Pathway

end Follow-

up Referral Pathway

start Pathway

end Follow-

up n=690 n=70 n=35 n=0 n=4973 n=383 n=159 n=46

Full time paid employment 5.9 8.6 2.9 . 9.0 8.1 5.0 6.5 Part time paid employment 7.0 11.4 11.4 . 7.5 11.5 11.9 4.3 Retired 25.5 20.0 17.1 . 25.5 25.1 24.5 50.0 Unemployed due to pain 42.2 32.9 34.3 . 35.6 36.3 34.6 19.6 Unemployed (not pain related) 5.5 11.4 2.9 . 5.2 6.8 6.3 0.0 Home duties 13.6 11.4 20.0 . 13.6 10.2 13.8 21.7 On leave from work due to pain 6.7 5.7 11.4 . 6.1 4.7 5.0 6.5 Studying (e.g. school, uni) 5.1 5.7 0.0 . 3.9 3.9 1.9 0.0 Voluntary work 2.8 7.1 5.7 . 3.1 4.4 5.0 8.7 Retraining 0.9 0.0 0.0 . 0.9 0.5 0.6 0.0 At work – limited hrs &/or duties 3.3 4.3 0.0 . 4.1 6.0 4.4 2.2 * Note percentages in this table will not sum to 100% as more than one work status may be chosen

Table 9 shows the percentage of patients where pain affects the number of hours they are able to work or study, and the percentage of patients where pain affects the type of work they are able to do. The results are also depicted in Figure 4 and Figure 5. All patients who returned a questionnaire in the reporting period are included in these results.

Table 9 Pain affects work or study

Pain affects work or study (percentage)


start Pathway

end Follow-

up Referral Pathway

start Pathway

end Follow-

up Pain affects number of hours able to work or study

n=714 n=75 n=39 n=0 n=5156 n=410 n=170 n=50 75.5 77.3 69.2 . 77.4 77.8 74.1 68.0

Pain affects type of work n=714 n=75 n=39 n=0 n=5156 n=410 n=170 n=50 78.3 77.3 82.1 . 80.4 78.3 77.6 82.0


Figure 4 Pain affects number of hours able to work or study

Figure 5 Pain affects type of work


2.3 Outcome measure 3 – Health service use Information about health service use is collected from patients as an outcome measure. At first glance, a reduction in health service use may appear to be a positive outcome, however, increased health service use may in fact reflect more appropriate use of services, for example a patient seeking regular sessions with allied health providers to assist in managing their pain. Caution should therefore be used in interpreting the information in the following table.

Table 10 shows the median number of times Enterprise One patients used each service in the last 3 months compared to all services for patients who returned a referral, episode end, and/or post-discharge follow-up questionnaire in the reporting period. Figure 6 shows the difference between referral and episode follow-up for health service contacts for Enterprise One patients.

Table 10 Health service use (median number of times used in the last 3 months due to pain)

Health service use

Enterprise One All Services Referral Episode

end Follow-up Referral Episode

end Follow-up

n=694 n=18 n=. n=4970 n=55 n=47 General practitioner 4 3.5 . 4 3 3 Medical specialist 0 0 . 1 0 1 Allied health professionals 0 0 . 0 0 1 Hospital emergency department 0 0 . 0 0 0 Admitted to hospital 0 0 . 0 0 0 Diagnostic tests 1 1 . 1 0 0 Figure 6 Health service use from referral to follow-up


2.4 Outcome measure 4 – Pain frequency A reduction in the frequency of pain is a positive outcome for a patient. Therefore an increase in the percentage of patients for whom pain is not always present or occurs less frequently is a positive outcome. Table 11 shows the percentage of patients at each level of pain frequency over the collection points in an episode for patients who returned a referral, pathway start or end, and/or post-discharge follow-up questionnaire in the reporting period.

Figure 7 shows the movement between each level of pain frequency through an episode cycle for Enterprise One.

Table 11 Pain frequency item (percentage of patients in each group)

Pain frequency


start Pathway

end Follow-

up Referral Pathway

start Pathway

end Follow-

up n=697 n=70 n=35 n=0 n=4971 n=391 n=160 n=46

Always present (same intensity) 14.5 10.0 8.6 . 22.0 14.3 11.3 6.5 Always present (varying intensity) 74.9 74.3 71.4 . 67.0 73.1 74.4 71.7 Often present 6.6 10.0 5.7 . 7.5 7.7 9.4 15.2 Occasionally present 3.0 2.9 2.9 . 2.4 2.6 2.5 4.3 Rarely present 1.0 2.9 11.4 . 1.0 2.3 2.5 2.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Figure 7 Pain frequency - Change through episode


2.5 Outcome measure 5 – Time from referral to first contact Time from referral to first contact can indicate responsiveness of pain management services to patient needs, or alternatively, availability of resources within the pain management service. Table 12 shows the distribution of time from referral to first contact for Enterprise One compared to all services for episodes that start within the reporting period. The time from referral to first contact is calculated as the date the referral is received to the episode start date (i.e. patient assessment or start of treatment). Figure 8 shows the position of Enterprise One in comparison to other services based on the time from referral to first contact.

Table 12 Time from referral to first contact

Time from referral to first contact Enterprise One All Services

Number Percentage Number Percentage <1 month 82 13.2 718 21.0 1-3 months 401 64.4 1672 48.9 3-6 months 100 16.1 668 19.5 6-12 months 32 5.1 290 8.5 >12 months 8 1.3 70 2.0 Average (days) 106.6 na 103.7 na Median (days) 58.0 na 62.0 na

Figure 8 Median number of days from referral to first contact (episode start)


2.6 Outcome measure 6 – Medication use Pain management services collect information about the medications their patients take and the frequency of their use. This information is provided to ePPOC as three variables, describing:

• whether or not a patient uses opioid medication on more than two days per week • the patient’s daily oral morphine equivalent (using a standardised conversion table) • the number of major drug groups the patient’s medications fall within. The major drug groups

are opioids, paracetamol, NSAIDs, antidepressants, anticonvulsants and benzodiazepines

Table 13 shows medication use for Enterprise One patients compared to patients for all services for questionnaires returned during the reporting period.

Table 13 Medication use

Medication use Enterprise One All Services

Referral Pathway start

Pathway end

Follow- up

Referral Pathway start

Pathway end

Follow-up

PATIENTS NOT ON OPIOID MAITENANCE PROGRAM n= n= n= n= n=3815 n=325 n=127 n=21 Percent of patients using opioids >2 days/week

55.8 47.7 37.8 52.4

Average daily morphine equivalent (mg)

62.7 46.3 27.4 54.7

Average number of major drug groups

2.9 2.4 2.1 2.3

PATIENTS ON OPIOID MAINTENANCE PROGRAM n= n= n= n= n=252 n=20 n=11 n=0 Average number of major drug groups (excluding opioids)

2.2 2.6 2.2 .


Section 3 - Descriptive analysis There are four levels of ePPOC data items – patient, episode, pathway and service events. The broad detail is found at the patient level, where the data items describe patient demographics.

The items at the episode level describe the way that pain management episodes start and end and include information about the patient’s pain and comorbidities at the start of the episode. The items at the pathway level categorise the type of intervention(s) the patient received, while the service event data items detail these interventions and allow evaluation of the intensity of treatment provided.

This section provides an overview of the data submitted by Enterprise One at each level for the current reporting period. Summaries of the data for all services are included for comparative purposes. See Appendix A for information on item completion.

3.1 Profile of pain management patients The information collected about each patient includes sex, indigenous status, country of birth, whether an interpreter is required and if a patient requires help with communication. The profile of patients is different from facility to facility so this must be taken into account when interpreting results.

Table 14 to Table 18 describe patients at Enterprise One compared to those at all services for patients active in the reporting period.

Table 14 Sex

Sex Enterprise One All Services

Number Percentage Number Percentage Male 331 43.4 2715 42.7 Female 432 56.6 3646 57.3 Total 763 100.0 6361 100.0 Table 15 Indigenous status

Indigenous status Enterprise One All Services

Number Percentage Number Percentage Aboriginal but not Torres Strait Islander origin 38 5.6 187 4.0 Torres Strait Islander but not Aboriginal origin 1 0.1 5 0.1 Both Aboriginal & Torres Strait Islander origin 1 0.1 5 0.1 Neither Aboriginal nor Torres Strait Islander origin

642 94.1 4475 95.8

Total 682 100.0 4672 100.0


Table 16 Country of birth

Country of birth Enterprise One All Services

Number Percentage Number Percentage Australia 606 86.0 3622 72.3 New Zealand 7 1.0 87 1.7 Other 92 13.0 1304 26.0 Total 705 100.0 5013 100.0 Table 17 Interpreter required

Interpreter required Enterprise One All Services

Number Percentage Number Percentage Yes 3 0.4 225 4.5 No 701 99.6 4828 95.5 Total 704 100.0 5053 100.0 Table 18 Communication assistance

Assistance required with communication Enterprise One All Services

Number Percentage Number Percentage Yes 98 14.0 631 12.5 No 603 86.0 4409 87.5 Total 701 100.0 5040 100.0

3.2 Profile of pain management episodes An episode of care is a period of contact between a patient and a pain management service. An episode of pain management begins with the first face-to-face contact with the patient and ends when:

• the pain management treatment is completed (including those where the patient will return for periodic reviews only)

• the patient is referred to another pain management service • the patient decides not to complete treatment, or • the patient dies.

Episodes at Enterprise One are described in comparison to those at all services in the following tables for active episodes in the reporting period.

Table 19 Age at referral by sex

Age at referral Enterprise One All Services

Male Female Male Female Average age (years) 50.9 50.8 51.6 53.2 Median age (years) 50.0 51.0 51.0 53.0


Table 20 Age group at referral by sex - distribution

Age group at referral

Enterprise One All Services Male Female Male Female

Number Percentage Number Percentage Number Percentage Number Percentage < 18 1 0.3 4 0.9 15 0.5 30 0.8 18-24 3 0.9 15 3.5 65 2.4 118 3.2 25-34 36 10.8 48 11.1 280 10.2 313 8.5 35-44 71 21.3 88 20.4 529 19.3 672 18.3 45-54 91 27.3 103 23.8 720 26.3 855 23.3 55-64 70 21.0 87 20.1 591 21.6 758 20.7 65-74 45 13.5 52 12.0 331 12.1 491 13.4 75-84 12 3.6 25 5.8 170 6.2 320 8.7 85+ 4 1.2 10 2.3 39 1.4 107 2.9 Total 333 100.0 432 100.0 2740 100.0 3664 100.0 Table 21 Compensation case

Compensation case Enterprise One All Services

Number Percentage Number Percentage Yes 41 5.9 470 9.4 No 654 94.1 4542 90.6 Total 695 100.0 5012 100.0 Table 22 Main pain site at referral

Main pain site Enterprise One All Services

Number Percentage Number Percentage Head 44 6.7 280 6.6 Neck 49 7.5 321 7.5 Chest 11 1.7 81 1.9 Back 286 43.7 1838 43.0 Leg 60 9.2 312 7.3 Arm/shoulder 53 8.1 411 9.6 Abdomen 35 5.3 226 5.3 Hands 15 2.3 75 1.8 Feet 26 4.0 134 3.1 Pelvic and/or genital 23 3.5 151 3.5 Buttock 21 3.2 166 3.9 Knee 30 4.6 150 3.5 Whole body 2 0.3 126 3.0 Total 655 100.0 4271 100.0


Table 23 Number of pain sites at referral

Number of pain sites Enterprise One All Services

Number Percentage Number Percentage 1-3 332 50.7 2210 51.7 4-6 247 37.7 1510 35.4 7-9 64 9.8 409 9.6 10+ 12 1.8 142 3.3 Total 655 100.0 4271 100.0 Table 24 Referral source

Referral source Enterprise One All Services

Number Percentage Number Percentage General practitioner/nurse practitioner 604 79.0 4965 77.5 Specialist practitioner 123 16.1 1020 15.9 Other pain management service 3 0.4 36 0.6 Public hospital 32 4.2 253 3.9 Private hospital 1 0.1 7 0.1 Rehabilitation provider/private insurer 0 0.0 87 1.4 Other 2 0.3 40 0.6 Total 765 100.0 6408 100.0 Table 25 How main pain began (precipitating event)

How main pain began Enterprise One All Services

Number Percentage Number Percentage Injury at home 63 9.4 336 6.9 Injury at work/school 135 20.2 1062 21.9 Injury in another setting 51 7.6 367 7.6 After surgery 73 10.9 525 10.8 Motor vehicle crash 73 10.9 465 9.6 Related to cancer 12 1.8 103 2.1 Related to another illness 64 9.6 525 10.8 No obvious cause 110 16.5 880 18.1 Other 87 13.0 596 12.3 Total 668 100.0 4859 100.0


Table 26 Cancer pain Cancer pain (is this episode of care for the management of cancer pain?)

Enterprise One All Services Number Percentage Number Percentage

Yes 1 0.1 44 0.9 No 705 99.9 5074 99.1 Total 706 100.0 5118 100.0 Table 27 Comorbidities

Comorbidities Enterprise One All Services

Number Percentage Number Percentage Depression/Anxiety 329 43.0 2183 34.1 Osteoarthritis, degenerative arthritis 212 27.7 1514 23.6 High blood pressure 209 27.3 1325 20.7 Diabetes 88 11.5 612 9.6 Heart disease 64 8.4 469 7.3 Ulcer or stomach disease 73 9.5 443 6.9 Rheumatoid arthritis 58 7.6 387 6.0 Lung disease 46 6.0 309 4.8 Stroke or neurological condition 46 6.0 303 4.7 Cancer 27 3.5 234 3.7 Anaemia or other blood disease 44 5.8 236 3.7 Kidney disease 24 3.1 152 2.4 Other medical problems 221 28.9 1666 26.0 * Note that the percentages in this table will not sum to 100% as patients may have more than one medical problem. Table 28 Pain duration

Pain duration Enterprise One All Services

Number Percentage Number Percentage Less than 3 months 16 2.4 122 2.5 3 to 12 months 80 11.9 588 12.2 12 months to 2 years 83 12.3 681 14.1 2 to 5 years 142 21.1 1113 23.1 More than 5 years 352 52.3 2309 48.0 Total 673 100.0 4813 100.0


Table 29 Episode start mode

Episode start mode Enterprise One All Services

Number Percentage Number Percentage Single or multidisciplinary assessment 76 12.2 2155 63.0 Treatment start 547 87.8 1263 37.0 Total 623 100.0 3418 100.0 Table 30 Episode end mode

Episode end mode Enterprise One All Services

Number Percentage Number Percentage Pain management service treatment completed 71 30.1 217 33.4 Referral to another pain management service 6 2.5 31 4.8 Did not complete treatment 107 45.3 175 26.9 Died 1 0.4 6 0.9 Primary treatment completed (ongoing review) 0 0.0 133 20.5 Other 51 21.6 88 13.5 Total 236 100.0 650 100.0 Table 31 Length of episode - summary Length of episode Enterprise One All Services Average length of episode (days) 97.8 96.0 Median length of episode (days) 58.0 43.0 Table 32 Length of episode - distribution

Length of episode Enterprise One All Services

Number Percentage Number Percentage <1 month 89 37.7 277 42.6 1-2 months 33 14.0 84 12.9 3-6 months 78 33.1 183 28.2 7-9 months 19 8.1 56 8.6 10-12 months 7 3.0 30 4.6 >12 months 10 4.2 20 3.1 Total 236 100.0 650 100.0


Table 33 Number of pathways per episode

Pathways per episode Enterprise One All Services

Number Percentage Number Percentage 1 189 94.5 385 93.2 2 10 5.0 26 6.3 3 1 0.5 2 0.5 4 0 0.0 0 0.0 5 0 0.0 0 0.0 6 0 0.0 0 0.0 7 0 0.0 0 0.0 8 or more 0 0.0 0 0.0 Total 200 100.0 413 100.0 Table 34 Service intensity - time per episode (for completed episodes)

Service intensity (average hours) Enterprise One

n=236 All Services

n=650 Total Telehealth Total Telehealth

Individual appointment with medical practitioner

0.2 0.0 0.5 0.0

Individual appointment with physiotherapist 0.1 0.0 0.2 0.0 Individual appointment with psychologist 0.0 0.0 0.1 0.0 Individual appointment with occupational therapist

0.0 0.0 0.0 0.0

Individual appointment with nurse 0.0 0.0 0.0 0.0 Individual appointment with more than one clinician

0.0 0.0 0.1 0.0

Individual appointment – other 0.0 0.0 0.0 0.0 Multidisciplinary team assessment 0.1 0.0 0.6 0.0 Multidisciplinary panel discussion 0.0 0.0 0.1 0.0 Telephone consultation with patient 0.1 0.0 0.1 0.0 Telephone consultation with patient’s doctor 0.1 0.0 0.1 0.0 Pain management program – group 2.9 0.0 6.9 0.0 Pain management program – individual 0.1 0.1 0.1 0.0 Procedural intervention – implant (drug delivery)

0.0 0.0 0.0 0.0

Procedural intervention – implant (neurostimulation)

0.0 0.0 0.0 0.0

Procedural intervention – non-implant 0.0 0.0 0.1 0.0 Procedural intervention – cancer block 0.0 0.0 0.0 0.0 Other 0.0 0.0 0.0 0.0 Total 3.6 0.1 9.0 0.1


3.3 Profile of pain management pathways The pain management pathway describes the broad type of intervention provided to the patient. There are four pain management pathway types:

• group pain management program(s) • individual appointment(s) • concurrent (both group and individual appointments) • one-off intervention.

Each episode would generally include one or more pathways, and the pathways can occur in any sequence. Information on active pathways within an episode is presented in the following tables. Table 35 Number of pathways by pathway type

Pathway type Enterprise One All Services

Number Percentage Number Percentage Group 468 75.6 866 35.8 Individual 102 16.5 1142 47.2 Concurrent 47 7.6 242 10.0 One-off 2 0.3 172 7.1 All pathways 619 100.0 2422 100.0

Table 36 Average pathway length (in days) by pathway type Pathway type Enterprise One All Services Group 89.6 63.0 Individual 80.1 91.3 Concurrent 193.2 147.2 One-off . 28.8


Table 37 Service intensity - time per pathway (for completed pathways)

Service intensity (average hours) Enterprise One

n=310 All Services

n=842 Total Telehealth Total Telehealth

Individual appointment with medical practitioner

0.2 0.0 0.4 0.0

Individual appointment with physiotherapist 0.2 0.0 0.3 0.0 Individual appointment with psychologist 0.1 0.0 0.1 0.0 Individual appointment with occupational therapist

0.0 0.0 0.0 0.0

Individual appointment with nurse 0.0 0.0 0.0 0.0 Individual appointment with more than one clinician

0.0 0.0 0.1 0.0

Individual appointment – other 0.0 0.0 0.0 0.0 Multidisciplinary team assessment 0.0 0.0 0.2 0.0 Multidisciplinary panel discussion 0.0 0.0 0.1 0.0 Telephone consultation with patient 0.2 0.0 0.1 0.0 Telephone consultation with patient’s doctor 0.1 0.0 0.1 0.0 Pain management program – group 4.1 0.0 8.8 0.0 Pain management program – individual 0.1 0.1 0.1 0.0 Procedural intervention – implant (drug delivery)

0.0 0.0 0.0 0.0

Procedural intervention – implant (neurostimulation)

0.0 0.0 0.0 0.0

Procedural intervention – non-implant 0.0 0.0 0.1 0.0 Procedural intervention – cancer block 0.0 0.0 0.0 0.0 Other 0.0 0.0 0.0 0.0 Total 5.0 0.1 10.3 0.1


References i Modified Brief Pain Inventory, reproduced with acknowledgement of the Pain Research Group, University of Texas, MD Anderson Cancer Centre, USA ii Lovibond, S. H. and P. F. Lovibond (1995). Manual for the Depression Anxiety Stress Scales. Sydney Australia, Psychology Foundation Monograph. iii Nicholas, M. K. (1989). Self-efficacy and chronic pain. British Psychological Society. St. Andrews, Scotland. iv Sullivan, M. J. L., et al. (1995). "The Pain Catastrophizing Scale: Development and Validation." Psychological Assessment 7(4): 524-532. v Dworkin, R. H., et al. (2008). "Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT Recommendations." The Journal of Pain 9(2): 105-121. vi Johnson, J. (2014, June 2). ACI Outcomes and Database Working Group. Meeting Minutes. vii Sullivan, M J L, (personal communication with Nicholas, M K, July 2014) viiiNicholas , M K (personal communication, July 2014)


Appendix A – Item completion Many items collected in epiCentre are mandatory. This section contains item completion information on those variables that are not mandatory. Table 38 Item completion (percent complete) - patient level Data item Enterprise One All Services Indigenous status 89.4 73.4 Country of birth 92.4 78.8 Interpreter required 95.9 94.7 Communication assistance 95.0 93.9 Table 39 Item completion (percent complete) - episode level Data item Enterprise One All Services Main pain site 91.4 83.0 Cause of pain 93.3 93.6 Pain duration 94.0 92.7 Work status 95.4 96.0 Pain affects number of hours able to work/study 95.4 96.4 Pain affects type of work 95.8 96.3 Health service use

General practitioner 93.2 93.5 Specialist 85.1 89.1 Allied Health 83.2 88.8 ED 81.2 87.6 Hospital admission 79.2 86.7 Diagnostic tests 82.5 85.7

Pain frequency 96.7 96.3


Table 40 Item completion – assessment tools

Outcome measure

Validity - Number of completed

items required

Enterprise One All Services Average number

of completed items Percentage of

validly completed questionnaires

Average number of completed items

Percentage of validly completed

questionnaires

BPI Worst pain 1/1 98.0 97.0

Least pain 1/1 96.7 96.1

Average pain 1/1 97.2 96.9

Pain now 1/1 96.8 96.7

Severity 4/4 6.9 94.4 6.9 94.7 Interference 4/7 6.8 98.5 6.8 98.0

DASS Depression 6/7 6.6 94.4 6.7 95.1 Anxiety 6/7 6.6 93.7 6.7 94.8 Stress 6/7 6.5 93.0 6.6 94.4

PCS Rumination 4/4 3.7 90.8 3.8 92.9 Magnification 3/3 2.8 89.8 2.8 92.7 Helplessness 6/6 5.6 87.8 5.7 91.2 Total 12/13 12.1 91.3 12.3 93.6

PSEQ Total 9/10 9.8 96.8 9.7 96.1

Table 41 Questionnaire response (percent returned) Questionnaire response* Enterprise One All Services Referral questionnaire 95.7 85.2 Pathway start questionnaire 83.3 73.9 Group program start (concurrent pathway) 100.0 72.2 Pathway review . 75.9 Group program end (concurrent pathway) 0.0 70.0 Pathway end questionnaire 26.9 46.3 Post-discharge follow-up questionnaire . 79.4 Ad-hoc questionnaire 88.0 91.2 * The number of questionnaires returned in the reporting period as a percentage of the number sent.


Appendix B – Relationship between levels of ePPOC data Five different levels of information are collected in epiCentre. These are:

1. Patient (e.g. date of birth, country of birth) 2. Episode – relating to the period of care at the pain service (e.g. referral date, comorbidities). A

patient may have one or more episode of care at one pain service or at different pain services. 3. Pathway – the type(s) of intervention provided to the patient. These can be group pain programs,

individual appointments, one off interventions, or a combination of group pain and individual appointments occurring concurrently. A patient may follow one or more pathways during an episode of care at a pain service.

4. Service event – the services provided to the patient during an episode of care. 5. Questionnaire – including the patient reported outcome measures e.g. DASS21, BPI.

Below is an example of how these levels of information are structured:

Patient reported outcomes are collected at:

• Referral – to record a baseline measure • Pathway starts and ends – to measure the effectiveness of interventions • Reviews (if a pathway lasts longer than 3 months) – to monitor change and

improvement within an episode • Three months after the episode ends (i.e. 3 months post discharge) – to

assess outcomes as a result of treatment at a service and whether improvements have been maintained.

Patient

Episode 1 Episode 2

Group program

Individual appointments

Patient

Service events

Episode

Pathway

Gro

up p

rogr

am –

20

hou

rs

Phys

io 1

hr

Phys

io 1

hr

Psyc

h 1

hr

Med

ical

1 h

r

Asse

ssm

ent 3

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Med

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1 h

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Acknowledgements

Contributions ePPOC wishes to acknowledge the valuable contribution made by:

Members of the National Reference Group, Scientific and Clinical Advisory Committee and Management Advisory Group

The many staff from pain management services who have spent

considerable time collecting, collating and correcting the data and without whose effort this report would not be possible

ePPOC staff at the Australian Health Services Research Institute, University of Wollongong, for the collation, analysis and reporting of the data

The Agency for Clinical Innovation for funding the establishment of this initiative

Disclaimer ePPOC has made every effort to ensure that the data used in this report

are accurate. Data submitted to ePPOC are checked for anomalies and services are asked to re-submit data prior to the production of the ePPOC report if necessary. We would advise readers to use their professional judgement in considering all information contained in this report.

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