Computer-assisted tool (QUAST) for documentation and quality assurance in pain treatment

Abstract

In chronic pain patient's diagnostic and therapy planning many complex information must be evaluated and analysed. The variety of data cannot be mastered without assistance of a database tool adapted to these special need. On the base of FileMaker Pro 5.0, a user-friendly and analysis-oriented database environment for documentation and quality assurance in pain therapy (QUAST) has been developed. QUAST has been tested for 2 years by 23 pain clinics in Germany including data of more than 14.000 patients. Among patients'demographic and clinical data all 335 fields of the validated German pain questionnaire are included in QUAST together with psychometric test procedures (CES, SES, PDI, SF-36). We developed a outcome questionnaire for the evaluation of treatment - related changes of outcome variables (103 fields), a daily questionnaire (11 fields) and a protocol to assess the effects of neural and other blockades (144 fields). All data of therapy and outcome can be documented (total number of the fields: 2661). The test results (e. g. in the form of total or compound scores) can be analysed and printed. For pain related diagnoses, procedures, blockades, drugs, expected and unexpected events hierarchical coding systems (altogether 72,157 data records) have been developed. These can be assigned automatically to coding systems like ICD-10 or ICP-M. Due to its ability of export into other databases and already enclosed routines QUAST permits an internal assurance of quality of process and outcome in pain management. It also can be an instrument of an external quality assurance. QUAST is at present the only computer system available in Germany, to fulfil the required prerequisites for adequate quality control.