SIP 2017 - Presentation & Statement
Prof. Dr. Winfried Meissner – Jena University Hospital, Germany
"Patient-reported outcome measures (PROMs) are an essential part of monitoring quality of care in pain management; however they have carefully to be chosen and applied."
Prof. Dr. Winfried Meissner
Head of Pain Unit and Palliative Care Department
Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital
Quality indicators (QI) are widely used in health systems to give an indication of quality of care. So far, most QIs are linked to parameters as mortality, complications, and resource use. Quality of life, pain or other “subjective” dimensions are rarely covered by QI. QI may measure quality directly (outcome) or indirectly (structures and processes). Indirect (surrogate) parameters should only be used if they are strongly linked to outcome quality. As a prerequisite, it is necessary to define “good outcome” for determining the appropriateness of QI. Most QI are based on quantifiable routine data. Patient-reported outcome measures (PROMs) – essential in the area of pain – are rarely used as QI. On the one hand, they are often considered as less “objective” than other data, on the other hand, assessment is resource-demanding because it needs direct interaction with the patient. An indicator should fulfill several conditions: it should be medically relevant and usable in (more or less) daily routine. In the area of pain, several QI have been proposed and/or used:
- Structure: Availability of dedicated personnel (e.g., Acute Pain Services), devices (e.g., PCA pumps)
- Processes: Regular pain assessments, use of protocols and treatments, prevention of complications, patient involvement, avoidance of i.m. injections
- Outcome: PROMs (e.g.,pain intensity, pain reduction, perception of care), complications, duration of stay, costs, long term consequences So far, few of these QI have been used in the context of generic quality assurance programs, and results are conflicting. Some process-related QI might even decrease overall quality by triggering over-treatment (“pain assessment as fifth vital sign”). On the other hand, other parameters have clearly been shown to be linked to increased quality of care (e.g., procedure and patient-specific pain management). In the talk, the potential benefits and problems of PROMs as QIs will be discussed.
After his residency as an anesthesiologist at University Hospital Berlin-Steglitz, Prof. Meissner was appointed head of Jena University Hospital’s Pain Unit in 1994, and head of the Palliative Care department in 2009. Since 2013, he is also head of the interdisciplinary Day Pain Unit.
His clinical expertise covers all aspects of pain management with a focus on acute pain and palliative pain treatment. He coordinates the two well-known acute pain registries QUIPS and PAIN OUT (www.pain-out.eu).