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Applying the PCMH Framework to Improve Chronic Pain Management for Patients in Wisconsin FQHC’s

Wisconsin Primary Health Care Association

Approved: December 2013

Grant Period: January 2014 – February 2015

RFP: Community-based Strategies for the Management of Chronic Pain


Applying the PCMH Framework to Improve Chronic Pain Management for Patients in Wisconsin FQHC’s

The overall goal of the Wisconsin Primary Health Care Association’s Community Health Pain Management Improvement project is to implement a sustainable and team-based Pain Peer Learning Network (PPLN) that is based on a PCMH framework and guideline-recommended practices for the care of patients with chronic pain. The anticipated project outcomes include improvements in patient and staff satisfaction and patient quality of life. We will accomplish this with the following objectives:

  1. WPHCA and Community Health Centers (CHC) PPLN teams will build upon WPHCA’s existing peer learning network structure and the PCMH model of care to implement system changes to improve care for patients with chronic pain.
  2. CHCs will identify a pain management improvement project and implement rapid improvement cycles to achieve their individualized goals.
  3. Participating CHC pain management teams will establish standardized evaluation and data methodologies to measure patient outcomes and patient and provider satisfaction.
  4. CHCs will develop relationships with external behavioral health specialists and/or increase internal behavioral health capacity to serve patients with chronic pain.
  5. CHCs will demonstrate awareness and utilization of non-pharmacological pain management options available to them by establishing new community collaborations, partnerships and referral sources.
  6. The pain management collaborative learning network will identify and share key recommendations and lessons learned with statewide, regional and national primary care networks.
  7. Explore the feasibility of integrating best practice pain management assessment, treatment monitoring, and evidence-based guidelines within Health Center EHRs for each CHC pain management team.