Presentation Recap: NCQA Chronic Pain Study May Have Health Equity Implications

June 17, 2021 · NCQA Communications

If someone in America is disabled, chronic pain is usually why.

Guideline recommend that clinicians use structured assessments to check how pain affects patients’ ability to move and do what they want.

Yet as common as chronic pain is, these tools really haven’t been used often in routine care.  So – we don’t know how clinicians respond when a patient reports that pain interferes with their life.

To help close that knowledge gap, the Agency for Healthcare Research and Quality (AHRQ) recently funded a study that NCQA Vice President for Research, Sarah Hudson Scholle, led: Predictors of Chronic Pain Diagnosis and Treatment Among Adult Federally Qualified Health Center Patients. The study took place at Community Health Center, Inc, (CHCI) a federally qualified health center network (and NCQA-recognized Patient-Centered Medical Home) in Connecticut. Sarah reported on the study on behalf of her co-authors at NCQA and CHCI on June 16, 2021, at the AcademyHealth Annual Research Meeting.

The study focused on more than 31,000 adults who received primary care at CHCI from July 2018 to June 2019. Almost one-third reported chronic pain. Dr. Scholle and her co-authors found that patients’ reports about how their pain affected their life, matters. That is, using common assessment tools to ask patients about their pain affected the treatment they received. This is an important finding, particularly in busy primary care clinics, where appointments are short and where most patients with chronic pain receive care.

The Equity Angle

Chronic pain and its treatment is an important quality topic. Chronic pain and its treatment is an important quality topic. For that reason alone, the study is worth reading: See the abstract for Predictors of Chronic Pain Diagnosis and Treatment Among Adult Federally Qualified Health Center Patients to learn more.

NCQA staff who were not involved in the study are interested in the study’s findings for another reason: because it shines a light on equity.

The study caught the attention of staff who work on equity issues because of how prominently Hispanic (Latinx) patients featured in the results:

• More than 40 percent of the patients who reported chronic pain were Hispanic. (For perspective, the Census Department estimates the Hispanic proportion of the US population at a little under 20 percent.)
• Latinx patients were more likely to receive a newly documented chronic pain diagnosis.
• Care for Latinx patients differed in several ways. For example, Latinx patients were less likely to receive opioid analgesics, behavioral health medications and behavioral counseling.

Anyone interested in understanding and ending unwarranted racial or ethnic disparities in health care and health outcomes would agree with authors’ concluding point: “Further exploration of ethnic differences is warranted.”

This study was one four studies NCQA staff presented at the AcademyHealth Annual Research Meeting. Others were:

• COVID-19 Disrupted Skilled Nursing Facility Utilization and Outcomes across Medicare Advantage Enrollee Subgroups
• Access to Medications for Opioid Use Disorder Among Medicare Fee-for-Service Beneficiaries: Where Are the Gaps?
• Trends in Timely Follow-up after Hospitalization, Adoption of Telehealth, and Association with 30-Day Readmission: Impact of the COVID-19 Public Health Emergency
• Quality of Behavioral Health Services and Integration with Primary Care

The primary source of funding for this study was from the Agency for Healthcare Research and Quality.