Moving Towards Patient-Centered Care in the Emergency Department: Importance of Improvement in Pain-Related Outcomes

Abstract

Musculoskeletal pain is a common emergency department (ED) presentation. Patient-centered care for patients with musculoskeletal pain may improve quality-of-life, satisfaction with care, and clinical outcomes. Providing patient-centered care in the ED requires understanding patients’ goals and priorities. We conducted a cross-sectional survey of the demographic, clinical, and biopsychosocial characteristics of adult ED patients (n=215) with musculoskeletal pain. Patients completed the Patient Centered Outcomes Questionnaire (PCOQ) to quantify importance of improvements in pain, interference with daily activities, fatigue, and emotion. Improvement ratings were from 0 (unimportant) to 100 (most important) and cluster analysis identified patient subgroups by these ratings. Comparisons used Kruskal-Wallis tests for continuous measures and Chi-Square tests for categorical measures. Patients with completed PCOQ were analyzed (n=176). All domains were rated as highly important (median/mean (sd) pain, interference, fatigue, and emotion ratings 100/91 (18), 96/79 (32), 93/72 (35), and 93/69 (39)). Cluster analysis identified three subgroups: 1) Multiple domains important (MDI, n=120) characterized by high importance for all domains 2) pain and function important (PFI, n=34) with high importance in pain and interference domains, and 3) only pain domain important (PI, n=22). The MDI group reported higher psychological symptoms, (p<0.0001 for both depression and anxiety symptoms) and was more likely female (p=0.019). The PI group had the least severe clinical characteristics including lowest weekly pain intensity (p=0.029), shortest time experiencing pain (p=0.003), and fewest symptoms from other body systems (p=0.034). ED patients with musculoskeletal pain seek improvements in outcomes beyond pain relief. Furthermore, the identification of three subgroups with differing priorities for their pain care may inform delivery of patient-centered care. These findings build on previous studies of the PCOQ and mirror subgroups from outpatient physical therapy settings. Additional research is needed to better validate these PCOQ subgroups and to longitudinally investigate their clinical utility. Musculoskeletal pain is a common emergency department (ED) presentation. Patient-centered care for patients with musculoskeletal pain may improve quality-of-life, satisfaction with care, and clinical outcomes. Providing patient-centered care in the ED requires understanding patients’ goals and priorities. We conducted a cross-sectional survey of the demographic, clinical, and biopsychosocial characteristics of adult ED patients (n=215) with musculoskeletal pain. Patients completed the Patient Centered Outcomes Questionnaire (PCOQ) to quantify importance of improvements in pain, interference with daily activities, fatigue, and emotion. Improvement ratings were from 0 (unimportant) to 100 (most important) and cluster analysis identified patient subgroups by these ratings. Comparisons used Kruskal-Wallis tests for continuous measures and Chi-Square tests for categorical measures. Patients with completed PCOQ were analyzed (n=176). All domains were rated as highly important (median/mean (sd) pain, interference, fatigue, and emotion ratings 100/91 (18), 96/79 (32), 93/72 (35), and 93/69 (39)). Cluster analysis identified three subgroups: 1) Multiple domains important (MDI, n=120) characterized by high importance for all domains 2) pain and function important (PFI, n=34) with high importance in pain and interference domains, and 3) only pain domain important (PI, n=22). The MDI group reported higher psychological symptoms, (p<0.0001 for both depression and anxiety symptoms) and was more likely female (p=0.019). The PI group had the least severe clinical characteristics including lowest weekly pain intensity (p=0.029), shortest time experiencing pain (p=0.003), and fewest symptoms from other body systems (p=0.034). ED patients with musculoskeletal pain seek improvements in outcomes beyond pain relief. Furthermore, the identification of three subgroups with differing priorities for their pain care may inform delivery of patient-centered care. These findings build on previous studies of the PCOQ and mirror subgroups from outpatient physical therapy settings. Additional research is needed to better validate these PCOQ subgroups and to longitudinally investigate their clinical utility.