A Prospective, Interventional Study Evaluating the Use of a Prompt to Improve Compliance with Documentation of a Plan of Care for Pain in Patients with Bone Metastases Seen for Palliative Radiation Therapy

Abstract

Management of cancer-related pain is an essential component of comprehensive oncologic care. Undertreated pain results in adverse clinical outcomes, undue suffering, and decreased quality of life. Furthermore, there are significant disparities in pain management, with racial/ethnic minorities and underserved populations at higher risk for undertreated cancer related pain. We studied whether the use of a simple electronic medical record (EMR) prompt could increase compliance with documentation of pain interventions in patients seen for palliative radiotherapy for bone metastases. A prospective, interventional study was approved by the Resident and Fellow Quality Improvement Incentive Program at our institution. Evaluable patients were seen in consultation for palliative radiation therapy for bone metastases. Resident physicians were asked to imbed a prompt in their consultation note, including pain scale (0/10) and plan of care for pain management. The primary endpoint was compliance rate of documenting a plan of care for >50% of audited patient encounters. The protocol aligned with Merit-based Incentive Payment System (MIPS) quality measures as defined by the Centers for Medicare Services. Quarterly EMR review was performed, with charts selected at random for auditing. Prior to initiation of the QI protocol, a pain intervention was documented in just 17.2% of patients. In the first 6 months following institution of the QI protocol, a plan of care for pain was documented in 65.5% of patients. The analgesic regimen was assessed or modified in 35% of consultations, urgent radiation therapy undertaken in 26%, communication with primary provider or oncologist in 10%, and referral to the Palliative Care service in just 4%. After institution of this protocol for patients being evaluated for palliative radiotherapy for bone metastases, substantially more patients had documentation of a plan of care for pain in accordance with MIPS quality guidelines. In addition to offering palliative radiation therapy, analgesics regimens were adjusted, referrals to palliative care were offered, and pain control was discussed with the referring provider. Ongoing efforts in our department are aimed at improving pain management and integrating radiation therapy with specialized palliative care providers.