Vohs Award Winner — Single - Region Category : KPNW Integrated Pain Management Program

MARILEE DONOVAN, RN, PhD, (top), joined KP in 1994, after a career including practice as an oncology nurse specialist, faculty in three colleges of nursing, and a hospital administrator. Through all of these roles, she has maintained a clinical practice and research interest in improving pain management. E-mail: [email protected]. PAUL O JACOBS, MD, (left), has been with Northwest Permanente in Portland, Oregon since 1974. He began as an Internist, and an interest in musculoskeletal pain led to a second residency in Physical Medicine and Rehab. In 1990, he began his practice as a Physiatrist. E-mail: [email protected]. MARTHA BLAKE, MBA, (right), Martha Blake served the NW Region as a Quality Program manager for fifteen years and actively sponsored the Pain Management Program. She is now training as an analytical psychologist at the C G Jung Institute, Zurich, focusing on the transformation and meaning of pain. E-mail: [email protected]. Background: Recognizing the Need to Integrate Pain Management One of the most common reasons for visiting a health care practitioner is to obtain relief from pain. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) reported that 50 million Americans are partially or totally disabled by chronic pain. Among those living in extended care facilities, incidence of serious pain is reported at 45% to 80%. On the basis of national data, Kaiser Permanente Northwest (KPNW) estimated, in 1995, that at least 5% of its adult Health Plan members were experiencing moderate to severe chronic pain (Bill Towery, MBA, MPP, personal communication, October, 1995). This level of pain was experienced by an estimated 9% of Kaiser Permanente (KP) San Diego members as reported by Bill McCarberg, MD (personal communication, July 24, 1999). In 1992, Group Health Cooperative of Puget Sound reported that although the cost of pain care per patient was lower than for other chronic conditions, total annual costs were greater. And although direct costs of pain treatment are estimated at $100 billion annually, only one in four patients receives effective treatment. In June 2001, a California jury awarded a $1.5 million settlement to a family whose terminally ill patriarch was discharged to hospice with his pain rated as 10 on a scale of 1 to 10 (a score of 10 indicating the most pain). Responding to increasing evidence of morbidity from unrelieved pain, the Robert Wood Johnson Foundation, in 1997, awarded the University of Wisconsin School of Medicine a grant to collaborate with JCAHO to develop what became the 2001 Pain Standards, which declare that every patient with pain has a right to have appropriate assessment and management of this pain.