Rationale / Objectives
Chronic pain is a growing problem for many patients with the economic costs of chronic pain in the U.S. exceeding that of the costs for cancer, heart disease and diabetes. Chronic postsurgical pain (CPSP) is one example which develops in 5-10% of patients within one year post-surgery. Inadequately controlled pain and the potential excessive analgesic use that can accompany it, have been shown to delay recovery and hospital discharge following surgery. CPSP can also result in depression, disability, and opioid dependency or abuse. To aid in the prevention of the development of CPSP for at-risk patients, the Toronto General Hospital (TGN) developed one of the first programs to address the problem of CPSP through implementation of its Transitional Pain Service (TPS). TGN partnered with the cloud-based smartphone app developed by ManagingLife called “Manage My Pain” to help track and monitor patients pain.
Project/Program Description & Major Achievements
TPS provides coordinated care with a multidisciplinary team to patients from before surgery for up to six months following discharge. By addressing the problem of CPSP at three stages: before the operation, postoperatively in the hospital, and up to 6 months post-surgery in an outpatient setting, the service can better address patients were are at risk for chronic pain. Patients at high risk for CPSP are identified early and offered coordinated and comprehensive care by the multidisciplinary team consisting of pain physicians, advanced practice nurses, psychologists, and physiotherapists. Upon hospital discharge, patients are commonly prescribed opioids for postsurgical pain relief which can lead to adverse effects. These and other negative effects of postsurgical pain can be prevented through communication and intervention by pain specialists in the critical 3-month period after surgery. With the implementation of the Manage My Pain app patients can report their pain related symptoms to their care team remotely. The app generates clinical reports with key metrics needed by clinicians from multiple disciplines and has a portal to monitor patient progress outside the clinic. Manage My Pain currently has over 24,000 users with over 500,00 pain records captured to date. In the pilot, the service is trending to deliver 75 times more patient-reported outcomes than current paper-based questionnaires.
One of the major lessons learned through the program is the benefits of technology in measuring patient progress. When comparing typical paper questionnaires to the Mange My Pain App, the paper questionnaires were insufficient in measuring patient progress. These limitations result in potentially needless suffering and raises risks for CPSP and opioid misuse.
TGN is Canada’s leading surgical center with more than 6,000 surgeries performed annually. Additionally, TPS patients have undergone a variety of surgical procedures including thoracotomy, mastectomy, and limb amputation after which as many as one in two patients may develop CPSP. The application pilot project partnership between TGN, Managing Life and York University began in December 2015, and is projected to last for 18 months. The app allows patients to stay on top of their pain and medication use on an hourly to daily basis and enables clinicians to quickly identify patients that are in distress. The patient’s app tracks their pain and function; and enables them to self-manage. The app then generates summary reports from the patient-reported outcomes for clinicians. The monitoring portal then provides real-time access to patient outcomes to help identify those at-risk.
The program was chosen by the Ontario Centres of Excellence’s AdvancingHealth program as one of the 5 projects awarded to healthcare innovators. The program has the opportunity to be one of the foremost quantifiable examples of using mobile health technology to help prevent CPSP and its associated costs. Manage My Pain currently has over 24,000 users with over 500,00 pain records captured to date. In the pilot, the service is trending to deliver 75 times more patient-reported outcomes than current paper-based questionnaires. The impact of Manage My Pain at the TPS will be measured by key clinical outcomes, including patients’ reports of pain intensity, opioid use, and functioning. This case study will be updated once more data becomes available.