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Mental Health Diagnoses are Not Associated With Indicators of Lower Quality Pain Care in Electronic Health Records of a National Sample of Veterans Treated in Veterans Health Administration Primary Care Settings

  • Steven K. Dobscha
    Correspondence
    Address reprint requests to Steven K. Dobscha, MD, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, R&D 66, Portland, OR, 97239.
    Affiliations
    Department of Psychiatry, Oregon Health & Science University, Portland, Oregon

    VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, Oregon
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  • Stephen L. Luther
    Affiliations
    Research Service, James A. Haley Veterans Hospital, Tampa, Florida

    College of Public Health, University of South Florida, Tampa, Florida
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  • Robert D. Kerns
    Affiliations
    VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut

    Yale School of Medicine Department of Psychiatry and Neurology, New Haven, Connecticut
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  • Dezon K. Finch
    Affiliations
    Research Service, James A. Haley Veterans Hospital, Tampa, Florida
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  • Joseph L. Goulet
    Affiliations
    VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut

    Yale School of Medicine Department of Emergency Medicine, New Haven, Connecticut
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  • Cynthia A. Brandt
    Affiliations
    VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut

    Yale School of Medicine Department of Emergency Medicine, New Haven, Connecticut
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  • Melissa Skanderson
    Affiliations
    VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut
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  • Harini Bathulapalli
    Affiliations
    VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut
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  • Samah J. Fodeh
    Affiliations
    VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut

    Yale School of Medicine Department of Emergency Medicine, New Haven, Connecticut
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  • Bridget Hahm
    Affiliations
    Research Service, James A. Haley Veterans Hospital, Tampa, Florida
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  • Lina Bouayad
    Affiliations
    Research Service, James A. Haley Veterans Hospital, Tampa, Florida

    Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida
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  • Allison Lee
    Affiliations
    VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut

    Yale School of Medicine Department of Psychiatry and Neurology, New Haven, Connecticut
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  • Ling Han
    Affiliations
    VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut

    Yale School of Medicine Department of Internal Medicine, New Haven, Connecticut
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Published:September 23, 2022DOI:https://doi.org/10.1016/j.jpain.2022.08.009

      Highlights

      • Diagnoses of post-traumatic stress disorder were associated with higher pain quality (PCQ) scores.
      • Other common mental health diagnosis categories were not associated with PCQ scores.
      • Married Veterans and Veterans with higher baseline pain levels had higher PCQ scores.
      • Hispanic ethnicity and cancer diagnoses were associated with slightly lower PCQ scores.
      • Sensitivity analysis using an alternative PCQ scoring algorithm showed similar results.

      Abstract

      Prior research has demonstrated disparities in general medical care for patients with mental health conditions, but little is known about disparities in pain care. The objective of this retrospective cohort study was to determine whether mental health conditions are associated with indicators of pain care quality (PCQ) as documented by primary care clinicians in the Veterans Health Administration (VHA). We used natural language processing to analyze electronic health record data from a national sample of Veterans with moderate to severe musculoskeletal pain during primary care visits in the Fiscal Year 2017. Twelve PCQ indicators were annotated from clinician progress notes as present or absent; PCQ score was defined as the sum of these indicators. Generalized estimating equation Poisson models examined associations among mental health diagnosis categories and PCQ scores. The overall mean PCQ score across 135,408 person-visits was 8.4 (SD = 2.3). In the final adjusted model, post-traumatic stress disorder was associated with higher PCQ scores (RR = 1.006, 95%CI 1.002–1.010, P = .007). Depression, alcohol use disorder, other substance use disorder, schizophrenia, and bipolar disorder diagnoses were not associated with PCQ scores. Overall, results suggest that in this patient population, presence of a mental health condition is not associated with lower quality pain care.

      Perspective

      This study used a natural language processing approach to analyze medical records to determine whether mental health conditions are associated with indicators of pain care quality as documented by primary care clinicians. Findings suggest that presence of a diagnosed mental health condition is not associated with lower quality pain care.

      Keywords

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