Exploring Referral and Service Utilization Patterns Within an Outpatient Interdisciplinary Pediatric Chronic Pain Program

Aimee K Hildenbrand; Christina M Amaro; Benjamin Bear; Catherine M Soprano; Katherine S Salamon

doi:10.2147/JPR.S430411

Exploring Referral and Service Utilization Patterns Within an Outpatient Interdisciplinary Pediatric Chronic Pain Program

J Pain Res. 2024 Feb 3:17:525-533. doi: 10.2147/JPR.S430411. eCollection 2024.

Authors

Aimee K Hildenbrand^{1

2

3}, Christina M Amaro^{1

4}, Benjamin Bear¹, Catherine M Soprano^{3

5}, Katherine S Salamon^{2

3}

Affiliations

¹ Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA.
² Division of Behavioral Health, Nemours Children's Hospital Delaware, Wilmington, DE, USA.
³ Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
⁴ Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
⁵ Division of Diagnostic Referral, Nemours Children's Hospital Delaware, Wilmington, DE, USA.

Abstract

Purpose: We examine referral sources and clinical characteristics for youth presenting to an outpatient interdisciplinary pediatric chronic pain program.

Patients and methods: Referral data were extracted from the electronic health record. PROMIS Pediatric Anxiety and Pain Interference Scales were administered at an initial evaluation visit.

Results: The program received 1488 referrals between 2016 and 2019, representing 1338 patients, with increasing volume of referrals over time. Referrals were primarily from orthopedics (19.6%), physical medicine and rehabilitation (18.8%), neurology (14.4%), and rheumatology (12.6%). Patients referred were primarily female (75.4%), White (80.1%), English-speaking (98.4%) adolescents (median=15.0 years). Of those referred, 732 (54.7%) attended an interdisciplinary evaluation (ie, with ≥2 disciplines). Adolescent anxiety was within the expected range by self-report (N=327, M_T-score=55.67) and parent proxy-report (N=354, M_T-score=57.70). Pain interference was moderately elevated by self-report (N=323, M_T-score=61.52) and parent proxy-report (N=356, M_T-score=64.02). There were no differences between patients referred who attended versus did not attend an interdisciplinary evaluation based on age, sex, ethnicity, or language. A smaller than expected proportion of referred Black patients (44%, P=0.02) and patients referred from orthopedics (40%) or pulmonology (11%) attended an evaluation, whereas a larger than expected proportion of those referred from physical medicine and rehabilitation (78%) were evaluated (P<0.001).

Conclusion: Results highlight the demand for outpatient interdisciplinary pediatric chronic pain treatment. Findings can inform decisions related to staffing and service design for pediatric hospitals that aim to establish or grow outpatient pediatric chronic pain programs.

Keywords: chronic pain; interdisciplinary; pediatric; referral; treatment.