Problem: Chronic Pain in Older Adults
Older adults (65+) are at high risk for developing chronic pain, encountering side effects from medications, and experiencing adverse outcomes related to opioids including Opioid Use Disorder (OUD). Existing American Geriatrics Society and CDC guidelines for chronic pain and opioid use among older adults are lengthy and difficult to reference during a clinical visit.
How Will I-COPE Help?
Improving Chronic Pain and Opioid Management Resources for Older Adults (I-COPE) aims to equip patients and providers with a toolkit that addresses chronic pain complications. The toolkit consists of a patient questionnaire, EHR smarset, and personalized action plan as part of the patient’s after visit summary.
What is the I-COPE Toolkit?
The patient survey elicits patient goals and preferences for their pain management. It consists of questions on their current pain, functional goals, and recent opioid use. The survey acts in conjunction with the provider’s input to create their care plan. The smartest is a clinical decision support tool that houses pain management information catered specifically for older adults. For example, recommendations on certain OTC medications are adjusted to meet the needs of the older adult population. Shared decision making (SDM) between patient and provider is encouraged with the use of the I-COPE Conversation Tool.
What is the I-COPE Conversation Tool?
The I-COPE Conversation Tool is a one-page document providers can use to show their patients all available options for pain management plans. Four treatment categories are listed: at-home treatments, in-person treatments, topical treatments, and pain relievers. Each of the four categories lists clinically supported pain management options that patients might consider for their plan. This tool is also available in Spanish.
Which Patients Are Eligible for I-COPE?
Patients are eligible for I-COPE if they are 65 or older and receive care at a study site clinic within the study period, have chronic pain (visit pain score ≥ 6 in the last 12 months, or chronic pain diagnosis on problem list, or chronic pain visit diagnosis in last 12 months) or ICD-10 code (F11.) in the problem list, or have past medical history or prior visit diagnosis. Opioid prescriptions are defined as any opioid prescribed for > 28 days in the 12 months.
The I-COPE smartset is catered toward those who fall in the above categories and appears as a Best Practice Advisory. However, the smartset can still be accessed while working with patients who do not qualify.
Partnership between ACCESS and UChicago Medicine
The University of Chicago is proud to be partnered with Access Community Health Network (ACCESS). For more than 25 years, ACCESS has been on the frontlines of community-based health care. ACCESS provides a continuum of care model that connects patients to health care resources both within and beyond the walls of their 35 federally-qualified health centers (FQHCs).
ACCESS’ services are designed to address the health of our underserved communities in such areas as preventive care, chronic disease management, and support services. To address patients’ comprehensive health needs, ACCESS physicians, nurse practitioners, midwives and other providers are teamed with outreach staff, case managers, social workers and substance abuse counselors to advance a continuum of care.
The University of Chicago Medicine, with a history dating to 1927, is a not-for-profit academic medical health system based on the campus of the University of Chicago in Hyde Park, and with hospitals, outpatient clinics and physician practices throughout Chicago and its suburbs. UChicago Medicine unites five organizations to fulfill its tripartite mission of medical education, research and patient care: Pritzker School of Medicine, Biological Sciences Division, Medical Center, Community Health and Hospital Division, and UChicago Medicine Physicians.
Grant Information
This tool was developed as part of AHRQ grant R18 HS027910.