Chronic Pain “Hotspots” in a Primary Service Area: Connecting: Population Health to Clinician Experience

Abstract

Chronic pain (CP, pain lasting more than three months) is a biopsychosocial condition that affects approximately 20% of the global population or ~50 million US adults. Certified nurse anesthetists observed clinical CP prevalence indicating local distribution bias. To assess this, a collaboration was formed between these clinicians and population-health researchers specializing in spatio-temporal health analytics. The goal of this study was to conduct a novel CP analysis at clinically relevant spatial scales and through a unique collaboration of clinicians and population health analysts. Most often, CP population studies are conducted at state or national levels. Our methods focus on a more appropriate clinician frame-of-reference, a primary service area (PSA) of a healthcare institution. We created a healthcare facility’s 30-minute drive time in which we geo-attached race/ethnicity and socio-economic variables to all 232 census tracts (CT). Then using an established source (Centers for Disease Control) CP calculations per race/ethnicity, economic variables, and age class, we calculated CP prevalence per CT and PSA. We conducted statistical “hotspot” analyses. We found that CP could be affecting 132,000 people in the PSA and that it differentially affects minorities and people of lower incomes. The hotspot results indicated that they accounted for 32% of the population, but ~ 40% of low income and 47% of Black PSA, CP prevalence. The “coldspots,” 11% of population accounted for 7% & 5% of PSA low income and Black CP, respectively. These types of collaborations and analyses will better inform clinicians and health professionals as the industry begins to shift away from fee-for-service and to value-based and capitation reimbursement models.