Duke’s PARTNER Program Adds Chronic Headache Collaboration

On Friday, January 15, 2016, Duke’s PARTNER Program (Pain Assessment Risk Treatments for Novel Effective Recovery) kicked-off a new initiative focused on adult patients who frequently visit the emergency department (ED) with a chief complaint of chronic headache or migraine. The PARTNER program is a collaboration between the Department of Neurology – Duke Headache Practice, Department of  Anesthesiology, Department of Surgery, Emergency Medicine Division, Department of Medicine, Hospital Medicine Division, Department of Case Management, and Duke University Medical Center to ultimately provide patients with “home rescue plans” for better headache pain management.

The PARTNER Chronic Headache program’s goal is to identify ED high utilizer patients with chronic headache and introduce them to novel, more effective management care pathways for their chronic headache condition, ultimately reducing the frequency of ED visits due to headache. “There’s a culture of going to the ED for problems that may not be necessary,” said Executive Vice Chairman, Solomon Aronson, MD. “We are trying to recondition behaviors.”

In early 2015, Duke Anesthesiology’s Perioperative Enhancement Team (POET) conducted a retrospective analysis of patients that had at least one visit to the ED in a six-month period for a chief complaint of pain. Based on this data, the DUH hospitalists were able to create a list to identify patients with more than five visits in a six-month period and design treatment plans for them. This was the beginning of the PARTNER program. After POET team members also noticed that many patients went to the ED with a chief complaint of migraine and/or headache, the PARTNER Chronic Headache program soon followed.

Headaches are widely prevalent, affecting between 16% and 22.7% of adults and are the fifth leading cause of emergency department visits in the United States, according to a May 2011 statistical brief by the Agency for Healthcare Research and Quality (AHRQ) titled “Headaches in U.S. Hospitals and Emergency Departments, 2008.”

The POET multidisciplinary team concluded that improving the care of headache patients through outpatient management, including routine use of headache preventative agents, may significantly decrease ED visits.

At the launch of PARTNER Chronic Headache, the stakeholders discussed the protocol for identifying possible patient candidates of this new initiative. By utilizing screening tools and a targeted DISCERN patient list, ED social workers will refer these patients to Timothy A. Collins, MD, chief of the Duke Department of Neurology Headache Division and a neurologist at the Duke Headache Practice (932 Morreene Road, Durham). Dr. Collins will create a treatment plan for each patient, which he emphasized will not include the use of opioids for chronic headaches or migraines. Instead, he will craft a “home rescue plan” for the patient to follow, ultimately preventing another ED visit.

At the conclusion of Friday’s meeting, Dr. Aronson thanked the entire PARTNER team for their help in growing the program. He revealed that there are other POET pilot programs currently in development. In the meantime, PARTNER will continue to find solutions to prevent overcrowding in the ED.

For more information about Duke’s PARTNER Program or Duke Anesthesiology’s Perioperative Enhancement Team (POET), please contact (919) 684-2918.