In pursuit of excellence: Pain management at the scientific watershed

Abstract

No one would argue with the premise that some form of measurement to assess the quality and success of treatment should be in place in any medical practice. Conventional wisdom would insist that this instrument incorporate scientific principles by paying rigorous attention to group selection; avoiding bias by the appointment of disinterested or blinded observers; planning all aspects prospectively; and last, but not least, using a statistical paradigm that is appropriate to the type of data being collected. The acquisition of such patient outcome information is obviously important, not just as a reflection of the success or failure of medical treatment, but to provide a foundation for either consolida­ tion or change, as the case may bey ,8 The rapid and exponential growth of pain medicine in the last 30 years has placed it squarely before the bench of medical opin­ ion, where professional and lay juries still have difficulty in defining its parameters of practice. In the focus article, David Brown addresses the whole issue of medical review, not just as it relates to pain medicine, but in the general context of medical delivery. The very complexity of contemporary medical practice lends itself, more than ever, to the instruments of indus­ trial measurement and Although still an art in many ways, medicine has subsumed the industri­ al model, a fact that has enabled the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to oversee issues of quality and improvement. The ulti­ mate marker-outcome-however, remains elusive. While the mandate of JCAHO has been to accredit hos­ pitals, it has expanded its oversight function to include ambulatory tacilities.? Nevertheless, as is emphasized by Brown, the JCAHO is mainly interested in the stan­ dardization of organizational performance. Pain medi