As we struggle to help staff adopt evidence-based pain management practices, I thought Dr. Brown's article offered an interesting way of thinking about best practices. She uses the word design deliberately to reflect the care and deliberation that are required for defining evidence-based care for populations of patients and delivering such care to individual patients. In essence, these tools address common, predictable aspects of care for a clinical population and rely heavily on research findings, quality improvement data, and incorporate system or institutional factors such as policies and resources. Clinicians' experiential knowledge can help with some aspects of pre-specified care such as system or clinical factors that will affect implementation of a guideline or subsets of patients whose care needs are likely to vary from interventions in the guideline. Point of care design means that clinicians must be able to tailor the care based on their knowledge of the patient.
Clinicians are accountable for the decisions they make to modify pre-specified care.
Brown offers some practical strategies that organizations and clinicians can employ to integrate institutional interests in research-based efforts to improve care with the clinician's interest in individualizing patient care. She maintains that both types of care design require expertise and institutional support such as research and clinical expertise, access to evidence sources, and computer resources. In pain management, we don't talk much about what it takes to get the job done. Brown gives us a way of understanding our efforts to institutionalize pain management practices that leave room for individualizing care. To read past PainLink Hot off the Press features, go to the Archives page .