A cultural transformation will require work at the community, state and national levels. Relieving Pain in America recognized pain as a major public health issue and encouraged public/private partnerships, including community-based initiatives. PAINS leaders believe that to generate the momentum and synergy necessary, not only must work be done at every level, but it is also essential to provide an inter-face between efforts.
PAINS leaders have extensive experience in healthcare transformation and community-health development. Community health development (CHD) is a process by which a community identifies factors influencing population health status and then assesses available resources to build the capacity to plan and take action to address the identified needs. CHD focuses on outcomes and sustainability (Burdine et al, 2007). In the late 1990s through early 2000s, the Center for Practical Bioethics, where PAINS is located, directed a national program of the Robert Wood Johnson Foundation to develop, support and fund statewide coalitions working to improve end-of-life care and was also a sub-contractor for another RWJF program focused on community-based initiatives working toward the same goal. PAINS Community Health Development Director, Michael Felix, was formerly a Program Officer at the Henry J. Kaiser Family Foundation and was responsible for developing and overseeing their state initiatives program. Based on this experience, PAINS was quickly drawn to a new model for healthcare reform developed at HHS called the Health Literate Care Model which incorporates principles of chronic disease management and health literacy into a comprehensive systems approach. (See Health Affairs) PAINS has incorporated both of these approaches into its efforts to develop and/or support community and state-based initiatives which embrace the IOM report’s Guiding Principles and are committed to establishing bio-psychosocial or integrative pain management as the standard of care in their community.
In 2012, PAINS agreed to partner with the Missouri Primary Care Association (MPCA) to develop a statewide initiative to improve pain care and to submit a CMMI proposal to support work with five communities in Missouri. MPCA and PAINS continue to await CMMI’s final decision; however, we have not waited to launch this work. One of the five communities in Missouri is Kansas City where, in partnership with hospitals, community-health centers, FQHCs, people living with pain and their family members, professional groups and not-for-profits, Relieving Pain in Kansas City is now being implemented. PAINS has also consulted with the Schools of Public Health and Life Sciences at Texas A&M which is now, in conjunction with TxPAIN, developing Relieving Pain in Texas. Communities across the US are developing plans or already working to “transform the way pain is perceived, judged and treated.” At PAINS 2nd Annual Meeting, leaders from Texas, Oregon, and Missouri (Kansas City | St. Joseph) spoke about their work, and PAINS is in conversation with other leaders in California, New Hampshire, Michigan, Indiana and Iowa about efforts in those states.
Each communitiy’s needs and assets are unique; “cookie cutter” approaches will not work. However, by providing connections among these efforts, PAINS believes groups can learn from one another, work smarter and progress faster than were they working independently. PAINS is committed to fostering communication which will, ultimately, facilitate the development of infrastructure at the community and state levels to provide the firm foundation necessary for implementation of the forthcoming National Pain Strategy Report.