Melanie Cole (Host):  Welcome to Back to Health, your source for the latest in health, wellness and medical care. Keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from out team of world renowned physicians at Weill Cornell Medicine. I’m Melanie Cole and today, we’re discussing the pain outcomes registries and how it helps doctors to better care for patients. Joining me, is Dr. Lisa Witkin. She’s the Site Director of Pain Management in Lower Manhattan at Weill Cornell Medicine. Dr. Witkin, it’s a pleasure to have you join us today. Let’s just start by explaining for the listeners what is a patient reported outcome measure?

Lisa Witkin, MD (Guest):  A patient reported outcome measure is any report of the status of a patient’s health condition that comes directly from the patient. And so patient reported outcome measures help us capture quality of life issues that patients care about and which often cause them to seek out care in the first place. It’s especially important in pain management as pain is inherently a subjective experience. Every patient experiences pain differently. What’s mild and tolerable for one person may be pretty severe and limiting for someone else. Using patient reported outcome measures, allows us to collect useful and validated data about how the pain affects the specific patient’s physical, social, mental and overall health and wellbeing.

Host:  Well thank you for that answer. People may not realize how important this is for patient centered care. So, tell us a little bit about the registry. What is a pain outcomes clinical registry and how does it work?

Dr. Witkin:  We can create a database using deidentified and secure information for all of the patients that are treated at our pain medicine sites as well as in our multidisciplinary spine center. And so this database or registry allows us to track trends and perform research and quality improvement projects to learn how to best treat patients. For example, we can study what types of patients or cohorts of patients do best with what types of treatments and we can collaborate with other academic institutions and national quality programs. And this research is important to guide future care of spine patients and chronic pain patients as it provides real world data as opposed to clinical trials which often don’t represent the patient population that we see on a daily basis.

Host:  So then because it does provide that real world data, how does it help doctors better care for patients Dr. Witkin?

Dr. Witkin:  So, it’s really important because while many providers may ask for a pain severity score for example a physician may ask on a scale of 0 to 10 how severe is your pain today. But as we talked about, it’s important for providers to understand and assess the impact of that pain on your quality of life. Prior to each visit with a provider at Weill Cornell Medicine, the physician is going to ask the patient to complete electronic questionnaires. And it’s important that the patient takes the time to fill these out because it provides valuable insight. It’s available securely via www.weillcornellconnect and it generates reports into our electronic medical record that will be available in real time. These reports are reviewed by your treating physician and help guide clinical decision making regarding the next steps in your care.

And as mentioned before, you’ll also be contributing in a secure deidentified manner to inform research projects for the greater good of other patients as well.

Host:  Dr. Witkin, give us an example of a health outcome and we know that medical technology allows the physician to measure – you know you can measure physical, physiological, biochemical data; but what is this data that can be obtained by the patient in these questionnaires? What are you talking about?

Dr. Witkin:  So, there a lot of different examples of health outcomes. There are some that are commonly measured by hospital systems and other agencies, things like morbidity and mortality for example, survivorship and complications with different cancer treatments is an example; but for pain management, really measuring a couple of things specifically related to treatment. So, we’re looking at mood and sleep symptoms including things like depression and anxiety as well as fatigue. We’re looking at the impact pain has on physical functioning, how pain can interfere in a variety of activities including the ability to participate in various roles and activities and then we’re doing a global health or an overall assessment summary as well.

Host:  Well then tell us, as a physician, what is health related quality of life? You just mentioned a few of them. Activities, being able to do functional activities and really have that quality of life but give us a few examples of what you’ve seen and why this is such an important distinction.

Dr. Witkin:  Health related quality of life is a concept that usually includes subjective evaluations of both positive and negative aspects of one’s life. As medical and public health advances have lead to cures and better treatments of many diseases and a longer life span; it’s just as important to assess patients in terms of improving their quality of lives as well. And so, as I mentioned, for pain patients, we often see a reduction in the pain severity scores but we’re also looking for our patients to have improved quality of life with respect to their mood, with respect to their sleep, with respect to their ability to function and do all of the activities that are important to them. And often these quality of life metrics are really what matters most to our patients.

Host:  That’s so interesting and since pain, specifically and what we’re talking about, is so subjective, as you said; how do you measure when you’re responding, you’re looking at these questionnaires and you’re talking to your patients; how do you measure what their pain is? Is it whether they can do those quality of life activities? Is it if it keeps them from enjoying those daily activities? How do you even measure something so subjective?

Dr. Witkin:  That’s what makes pain management so interesting. And so, that’s why it’s really important to try to measure all of these different domains when you are assessing the patient. So, it’s important to measure pain severity which is something we do at all of our visits but again, we want to know how the pain affects their quality of life on a daily basis. Some of that information we can learn from the questionnaires and then some of that information we can gather as we discuss with the patient during the clinical encounter.

Host:  What type of providers might this be useful for Dr. Witkin?

Dr. Witkin:  These health related quality of life measurements have been shown to be useful in a variety of settings and disease states. But again, I believe it’s especially important for conditions that are difficult to objectively measure. For example, we talked about how treating chronic pain is very different than treating conditions like high blood pressure or diabetes for example when there are very specific blood pressure or blood glucose goals that we can measure and track over time with well-established targets for treatment. Instead, pain is subjective and so getting this data and information from patients is really important to set goals and monitor the progress of treatment. While we follow the numerical pain score over time, there’s no other objective way to capture how the patient’s overall functioning has improved with treatment other than these patient reported outcome metrics.

Host:  What an interesting topic. Dr. Witkin as we wrap up, explain to the listeners just kind of give us a summary about pain outcome registries and how this helps Weill Cornell Medicine to be a true patient centered healthcare system.

Dr. Witkin:  It allows our physicians to provide patient-centered care that’s integrated, that’s multimodal, that’s multidisciplinary across all of the specialties that treat conditions at the spine center and all components of which should be evidence based. And it allows us not just to treat this specific individual patient but also to learn how to best treat future pain patients at a population level as well. We can also individualize treatment by learning what matters most to the patient that we’re treating at that time.

Host:  It’s really important and such great information. Thank you so much Dr. Witkin for joining us today and telling us about the pain outcome registries. Additionally, Weill Cornell will continue to offer video visits always so patients that do not wish to travel can schedule a Telehealth visit and appointments can be made in person if they require a procedure. Thank you so much for joining us today and that’s concludes today’s episode of Back to Health. We’d like to thank our listeners and invite our audience to download, subscribe, rate and review Back to Health on Apple Podcasts, Spotify and Google Play Music. For more health tips go to www.weillcornell.org and search podcasts. And parents, don’t forget to check out Kids Health Cast. I’m Melanie Cole.