Improving Primary Care Management of Joint Pain through a Pi/Qi-CMe Approach

Gary C. Bird, Rick Kennison


Background: As the population ages, the number of patients reporting a complaint of joint pain is set to expand rapidly, greatly increasing the burden on the healthcare system in the United States. At present, however, the st line of patient contact—primary care—is ill-equipped to deal with this growing crisis. Here we report the results of a 6-month, site-based combined Performance/Quality Improvement and continuing medical education (CME) activity designed to demonstrate improved healthcare provider performance at the primary care level.

Methods: This activity was cfor continuing education credit for physicians, nurse practitioners, and physician assis-tants. The activity followed the Plan-Do-Study-Act process, and was based on the American Medical Association’s 3-stage methodology for performance improvement coupled with CME. Performance change was measured by comparing prospec-tive joint pain patient and practice ww data before and after implementation of evidence-based tools and resources into participant practices. Data obtained were subsequently assigned as level 5, according to Moore’s expanded outcomes framework, 2009.

Results: A total of 78 healthcare providers in 49 sites took part in this activity, and 1070 joint pain patients were reviewed. After the tools and resources had been implemented, statistically ant improvement was obtained in the management of these patients using clinically objective measurements with regards to provider diagnostic skills and the overall speed of the diagnostic process. Communication between the provider and the patient was noted to improve, and some evidence of an improvement in the referral process was observed. In addition, providers that chose to re-evaluate their entire practice ww self-reported improvease in patient volume.

Conclusion: This initiative’s positive impact on provider performance successfully demonstrates how Performance/Qual-ity Improvement methodology may be coupled with CME to improve primary care performance for a burdensome chronic complaint. The inference that outcomes for patients with a complaint of joint pain will be concomitantly improved by this activity is discussed.

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