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2021 QCDR Measure #003: Pain Interference Response utilizing PROMIS

Measure TitlePain Interference Response utilizing PROMIS
Measure DescriptionThe percentage of adult patients (18 years of age or older) who report pain issues and demonstrated a response to treatment at one month from the index score
DenominatorAdult patients (18 years of age or older) who report pain issues as significantly impacting their life
NumeratorThe number of patients in the denominator who demonstrated a response to treatment, with a result that is reduced by 2-6 points or greater from the index score, one month (+/- 21 days) after the index visit.
The following are meaningful change scores indicated by various types of chronic pain:
• Change of 3.5-5.5 points (used CAT with back pain samples) Amtmann
• Change of 2-3 points (used short forms with chronic pain samples) Chen
• Change of 3.5-4.5 points (used short forms with stroke sample) Chen
• Change of 2.35-2.4 points (used short form with knee OA sample) Lee
• Change of 4.0-6.0 points (used 10 item short form with cancer sample) Yost
Denominator ExclusionsPatients who die or are enrolled in hospice are excluded from this measure.
Denominator ExceptionsNone
Numerator ExclusionsNone
National Quality Strategy (NQS) DomainEffective Clinical Care
Measure TypePatient Reported Outcome (PRO)
High PriorityYes
Measure Risk-Adjusted?No
Meaningful Measure AreaFunctional Outcomes
Meaningful Measure Area Rationale Using a standardized measure to assess pain will improve both quality of treatment and efficient use of resources. Measuring improved pain response in treatment (i.e., interference) will promote interventions and best practices, such as nonpharmacological treatments, that are effective at reducing symptoms and improve functional status and quality of life.
Inverse MeasureNo
Proportional MeasureYes
Continuous Variable MeasureNo
Ratio MeasureNo


Measure Rationale

Pain is among the most prevalent, persistent, and costly health conditions in clinical practice as well as the general population. Moreover, musculoskeletal pain conditions account for four of the nine most disabling diseases. [1] Chronic pain, lasting present on most days for three months or longer, is experienced by an approximate 11.2% of Americans, although some surveys have estimated this to be closer to 30% common among adults with prevalence estimates as high as 40% of adults while bothersome chronic pain affects 20 to 25 percent of adults. Chronic pain with major life activity impacts affects about 10 percent of the adult population. [2,3] Chronic pain is more prevalent for women than men, tends to increase with age, is mainly most commonly attributed to low back followed by and osteoarthritis pain and is reported as severe for about a third of respondents. [3] But persons with persistent pain with life activity impacts frequently report pain at multiple body sites or anatomically diffuse pain. In some populations the prevalence of chronic pain may be higher, such as in up to 50% of those who are veterans. [4] Chronic pain with life activity impacts is complex and unique to individual patients, often occurring along with comorbidities including obesity, depression, anxiety, and post-traumatic stress disorder. [5,6,7] Psychological interventions for management of chronic pain are a useful approach, that can reduce pain and catastrophizing beliefs, and improve pain self-efficacy for management, particularly in older adults
1. Kroenke, K. (2018). Pain Measurement in Research and Practice. J Gen Intern Med, 33:1, S7-8.
2 National Center for Complementary and Integrative Health. Pain in the U.S., August, 2015. Available:
3 Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain. 2010 Nov;11(11):1230-9.
4 Kerns RD, Otis J, Rosenberg R, Reid MC. Veterans’ reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system. J Rehabil Res Dev. 2003 Sep-Oct;40(5):371-9.
5 Narouze S, Souzdalnitski D. Obesity and chronic pain: systematic review of prevalence and implications for pain practice. Reg Anesth Pain Med. 2015 Mar-Apr;40(2):91-111.
6 Stubbs B, Koyanagi A, Thompson T, Veronese N, Carvalho AF, Solomi M, et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen Hosp Psychiatry. 2016 Nov – Dec;43:63-70.
7 Otis JD, Keane TM, Kerns RD. An examination of the relationship between chronic pain and post-traumatic stress disorder. J Rehabil Res Dev. 2003 Sep-Oct;40(5):397-405.

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