Committee found three of six measures to be valid for internal medicine physicians, suggests an additional performance measure based on current guideline
Oct. 11, 2024 (ACP) -- In its most recent review of performance measures, the American College of Physicians Performance Measurement Committee (PMC) evaluated quality indicators for pain in adults and found that three of six measures are valid for internal medicine practice.
In a paper published in the Annals of Internal Medicine, the PMC concludes that three of the measures for pain are considered evidence-based, scientifically sound and actionable in health plan settings.
“If we are going to use performance measures, we need to be thorough and look at them through various lenses and make sure that they are improving patient care and not overly burdensome to physicians,” said PMC Committee Vice-Chair Dr. Caroline Goldzweig.
One measure assesses adults with a principal diagnosis of low back pain who did not have an imaging study within 28 days of their diagnosis.
Many patients with low back pain receive imaging studies, but these studies do not improve patient outcomes, are associated with costs and expose patients to unnecessary radiation, the paper explains. A higher score indicates better performance in this measure, which is designed to rein in the overuse of imaging for low back pain.
The PMC looked at the measure at the individual physician, group practice and health plan levels. This measure passed muster in health care plans, but it was not designed for use at the individual or group practice levels, Goldzweig noted. “It's a good measure based on high-quality evidence,” she said.
The opioid epidemic has devastated communities across the United States, and opioid stewardship is an important part of the solution to this crisis. Two measures aim to address the appropriate use of opioids and were supported by the PMC. These measures have merit in health care plans, Goldzweig explained.
Unfortunately, many of the current performance measures for pain management do not tick all the necessary boxes across health care settings.
A measure that ACP does not support involves the concurrent use of opioids and benzodiazepines, but it does not accurately reflect use patterns. Opioids and benzodiazepines can increase the risk for overdose because both can cause sedation and suppress breathing. “A person may have a prescription for Xanax to take when they fly, but this does not mean they regularly take it with an opioid,” Goldzweig explained. “Concurrent prescribing is different from concurrent use.”
In addition to reviewing six measures, the PMC also sought to fill some gaps and design a measure that will identify new opioid prescriptions. They examined three recommendations from the ACP and American Academy of Family Physicians (AAFP) clinical guideline “Nonpharmacologic and Pharmacologic Management of Acute Pain from Non-Low Back, Musculoskeletal Injuries in Adults.”
While two of the three ACP/AAFP recommendations were not feasible, the third recommendation that advises clinicians against treating patients with acute pain from non-low back musculoskeletal injuries with opioids may serve as the basis of a quality measure in the future. The authors recommend a measure that may help capture overuse in opioid prescribing for acute pain.
More Information
The position paper, “Quality Indicators for Pain in Adults: A Review of Performance Measures by the American College of Physicians,” is available on the Annals of Internal Medicine website.
Back to the October 11, 2024 issue of ACP Advocate