Reducing the high cost of pain: Remote monitoring surveys help patients avoid pain and the ED

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Every day, Americans receive medical care in hospital EDs for preventable and non-emergency issues. Pain is one of the most common of those issues. In fact, a study in the Journal of Emergencies, Trauma and Shock found that at least 75 percent of patients present to the ED with a chief complaint related to pain. Despite the fact that pain can almost always be treated most effectively and cost efficiently outside of the ED, it sends patients across the U.S. to the emergency department regularly. When it is not managed effectively and efficiently, pain comes with a hefty price tag. The American Academy of Pain Medicine reports that, if you factor in the cost of care, medication, ED visits, hospitalizations, missed work and even decreased productivity tied to pain, the overall cost of pain amounts to at least $560-635 billion annually. Managing pain proactively, rather than in the ED, is necessary in order to drive down the high cost of treating it. Fortunately, there are steps healthcare providers and organizations can take-like using surveys to remotely monitor patients-to improve pain management and reign in healthcare costs.

Pain has many different causes; it can be a symptom of a chronic disease or its own unique chronic health concern. The Centers for Disease Control and Prevention estimates that 50 million Americans (or roughly 20 percent of the adult population in the U.S.) experience chronic pain. Healthcare teams can best serve patients with both chronic conditions and chronic pain by remotely monitoring their health and proactively responding to issues. To monitor their patients, healthcare teams can use the patient engagement technology they currently use for appointment reminders to send patients invitations to complete online health monitoring surveys. Then, as patients respond, providers can use the information they capture to track health markers and determine when interventions are required.

Remote monitoring not only helps healthcare providers reduce the likelihood of patients in pain heading to the emergency department for care, it provides patients with the between-visit support they desperately want. A West survey revealed that patients know they need help managing pain and chronic conditions, and they are eager to receive between-visit support from healthcare providers. West’s survey, which garnered responses from 1,036 adults and 317 healthcare providers in the U.S., found that nearly eight in ten patients with chronic conditions (79 percent) are interested in participating in remote health monitoring surveys. More specifically, patients with CHF (91 percent), obesity (84 percent), diabetes (82 percent), high cholesterol (76 percent) and hypertension (76 percent) are interested in taking remote health monitoring surveys from their healthcare providers. 

West’s survey also revealed that 62 percent of healthcare providers feel it is “very” helpful for patients to complete remote monitoring surveys. These providers feel strongly that it is important to be able to identify and respond to pain and other issues in the correct setting. And they feel surveys can help accomplish this. Unfortunately, even though healthcare providers see value in remote monitoring surveys, very few are using them to check in with patients. According to West’s survey, just 7 percent of healthcare providers say they use online surveys or check-ins to regularly monitor how well pain and other conditions are being managed. Healthcare teams clearly have opportunities to better use surveys to identify issues related to pain and respond with appropriate interventions. Here are a few examples of simple ways healthcare teams can leverage surveys to make pain management more proactive. 

Ask chronic patients about their symptoms and pain. Providers can ask survey questions, like the following, to identify if patients are experiencing pain, and if so, whether it is severe.

      Which best describes your pain experience over the past 48 hours? 

o   I have not had pain.

o   I have had minimal pain.

o   I have had average pain.

o   I have had a high level of pain.

o   I have had debilitating pain.

      If you are currently experiencing pain, rate your pain on a scale from 1 to 10. (10 = the worst pain imaginable)

If patients’ survey responses indicate that they have unmanaged or severe pain, they should be considered a high risk for going to the ER for treatment. Following-up with these patients immediately is recommended.

Find out if patients are having success using medication to control pain. Many patients struggle with medication adherence. These sample questions show examples of the types of questions teams can ask to find out if patients are taking their prescribed medications, if they understand medication instructions, if they are experiencing side effects and if medication is helping reduce pain.

       Have you taken oral medication to control pain at any point in the past week?

o  Yes

o  No

      Does the pain medication prescribed by your doctor reduce your pain?

o  Yes, it is very effective. 

o  Yes, it alleviates pain somewhat.

o  No, it has little impact.

o   I have not taken the pain medication prescribed to me.

When patients indicate they are not taking prescribed medications, they are experiencing bothersome side effects or medication is not working, staff can contact them to discuss ways to overcome these issues.

Track changes over time. Pain-related ED visits often happen when pain worsens or becomes so persistent patients can’t find relief. Survey questions like these examples can help providers see if patients’ pain is increasing (along with their risk of utilizing the ED):

           Has your pain level increased, decreased or stayed the same in the past week? 

o  Increased

o  Remained the same

o  Decreased

Is your pain constant, or does it come and go?

o  Pain is constant

o  Pain comes and goes

If a patient ranks their level of pain as being a two on the pain scale one week and an eight the following week, that should be a red flag for providers. Having this insight allows healthcare teams to intervene and find solutions before pain sends patients to the ED. 

Too many patients end up in the ED or admitted to the hospital because of chronic pain. By utilizing health monitoring surveys, and actively following up with patients who are at risk for utilizing the ED, healthcare teams can help patients in pain get fast, effective and cost-efficient care. Without between-visit monitoring and support from their providers, patients often don’t have the know-how to effectively manage their pain. But when patients get extra support from their healthcare team, they can use the ED more judiciously. And that helps prevent unnecessary healthcare expenses. 

Allison Hart is a regularly-published advocate for utilizing technology-enabled communications to engage and activate patients beyond the clinical setting. She leads thought leadership efforts for West’s TeleVox Solutions, promoting the idea that engaging with patients between healthcare appointments in meaningful ways will encourage and inspire them to follow and embrace treatment plans - and that activating these positive behaviors ultimately leads to better outcomes for both healthcare organizations and patients. Hart currently serves as vice president of marketing at West, where the healthcare mission is to help organizations harness communications to expand the boundaries of where, when, and how healthcare is delivered.