"The Pain Doesn't Have to Control You." A Qualitative Evaluation of Three Pain Clinics Teaching Nonopioid Pain Management Strategies.

PURPOSE: To explore factors related to effectiveness of nonpharmacological treatment for opioid-dependent patients suffering with chronic pain. APPROACH: A qualitative study incorporating individual interviews and focus group interviews. SETTING: 3 rural Oregon nonopioid pain management clinics. INTERVENTION: A 10-week nonpharmacological educational program incorporating cognitive-behavioral therapy, movement therapy, mindfulness, and other skills. PARTICIPANTS AND METHODS: Across sites, we conducted 9 individual interviews with clinic staff and 3 focus group interviews with 34 patients who had participated in the course. Thematic analysis was used to identify themes within and across respondent groups. RESULTS: Analysis revealed 4 primary themes: program goals; program benefits; characteristics of patients who benefit from the program; coordination of clinic experiences with other care. Several primary findings can be highlighted. The clinics focused on improving patients' quality of life, while opioid use reduction was a potential secondary benefit, driven by patients. Major program benefits included enhanced pain self-management skills, patients' greater assertiveness in communications with healthcare providers, and, in numerous cases, opioid use reduction. Participants were unanimous that predisposition toward active self-management of one's pain was an essential factor for positive outcomes. Patients reported considerable variability in providers' understanding of their clinic participation. CONCLUSION: Nonpharmacological approaches for treating chronic pain can be effective for many patients. Clinics teaching these approaches should be more fully integrated into the healthcare system.

Producing public reports of physician quality at the community level: the Aligning Forces for Quality initiative experience.

OBJECTIVES: To describe the approaches used by the Aligning Forces for Quality (AF4Q) alliances in producing community-based reports of physician quality and to assess the contribution of these reports to existing physician performance information. STUDY DESIGN: The study included semi-structured interviews with alliance stakeholders and tracking of the number and content of physician performance reports in 14 AF4Q initiative communities and 7 comparison communities. METHODS: The study used qualitative analysis of interview data and systematic tracking of the number and content of physician performance reports over time. RESULTS: Report production occurred in several stages including initiation, measure selection/specification, measure construction, and dissemination. The measure selection/specification process was often the first major act undertaken by alliances under the AF4Q initiative grant. Alliances utilized nationally endorsed performance measures and made a strategic decision to gain buy-in with physicians. Alliances have experienced greater difficulty in producing buy-in for patient experience measures. The primary decision point for measure construction was the use of administrative claims data or physician-provided medical records data. Overall, AF4Q alliances have contributed to an increase in physician performance information in their communities. CONCLUSIONS: Our findings suggest that the AF4Q initiative has accelerated the development and content of physician performance measures in AF4Q communities.

Using websites to engage consumers in managing their health and healthcare.

OBJECTIVE: This study provides insight into the potential of local community health information websites to cultivate and support consumer engagement through website positioning and content choices. STUDY DESIGN: This descriptive study compared health-related websites maintained by 16 multi-stakeholder community alliances charged with improving consumer engagement and public reporting of provider performance data. METHODS: We systematically assessed website messaging, content, and the presence of explicit connections among information and tools related to consumer engagement behaviors for 32 websites maintained by alliances as of November 2011. These findings were triangulated with information about alliances' public reporting activities from key informant interviews (2007-2011) with stakeholders in 14 alliances. RESULTS: A total of 25 of the 32 alliance websites contained information for consumers, and 14 of those included information related to at least 3 of 4 consumer engagement behaviors: shopping for high-quality providers or treatments, self-advocacy in healthcare encounters, self-management of illness, and partaking in general healthy behaviors. Positioning strategies and tactics to attract consumers varied widely across alliances. Some targeted specific conditions or behaviors; others took a broader community approach. Two alliances had strong alignment between website messaging and consumer engagement content, 7 had moderate alignment, and 7 had limited alignment. CONCLUSIONS: Although alliances have been experimenting with a wide array of website approaches, their promise as a tool to improve consumer engagement is still uncertain. Further research that addresses the comparative value of different website approaches is needed.

A report card on provider report cards: current status of the health care transparency movement.

BACKGROUND: Public reporting of provider performance can assist consumers in their choice of providers and stimulate providers to improve quality. Reporting of quality measures is supported by advocates of health care reform across the political spectrum. OBJECTIVE: To assess the availability, credibility and applicability of existing public reports of hospital and physician quality, with comparisons across geographic areas. APPROACH: Information pertaining to 263 public reports in 21 geographic areas was collected through reviews of websites and telephone and in-person interviews, and used to construct indicators of public reporting status. Interview data collected in 14 of these areas were used to assess recent changes in reporting and their implications. PARTICIPANTS: Interviewees included staff of state and local associations, health plan representatives and leaders of local health care alliances. RESULTS: There were more reports of hospital performance (161) than of physician performance (103) in the study areas. More reports included measures derived from claims data (mean, 7.2 hospital reports and 3.3 physician reports per area) than from medical records data. Typically, reports on physician performance contained measures of chronic illness treatment constructed at the medical group level, with diabetes measures the most common (mean number per non-health plan report, 2.3). Patient experience measures were available in more hospital reports (mean number of reports, 1.2) than physician reports (mean, 0.7). Despite the availability of national hospital reports and reports sponsored by national health plans, from a consumer standpoint the status of public reporting depended greatly on where one lived and health plan membership. CONCLUSIONS: Current public reports, and especially reports of physician quality of care, have significant limitations from both consumer and provider perspectives. The present approach to reporting is being challenged by the development of new information sources for consumers, and consumer and provider demands for more current information.