Date of Publication


Project Team

Dr. Margaret Aitken; Kristina DuPrat; Gracie Lanphear


Background: Chronic pain is prevalent in the United States. Frequently, rural primary care providers must manage patients’ chronic pain and any associated long-term opioids. Best evidence-based practices recommend, and in some cases state guidelines require, periodic functional assessment, for which the CDC endorses the PEG assessment scale.

Purpose: To integrate the PEG assessment scale into a rural, primary care practice and evaluate sustainability in following best evidence-based practice guidelines.

Methods: A one-year retrospective chart review determined the baseline quality and frequency of functional assessment. A pre-implementation survey was distributed to providers to assess knowledge of opioid prescribing guidelines and their perceived applicability and importance to practice. The PEG assessment scale was implemented in a six-week series of PDSA cycles. Weekly retrospective chart reviews evaluated rate of completion. A post-implementation survey was sent to providers to gauge satisfaction and feasibility of continued use.

Results: Implementation increased the percentage of patients with chronic pain managed on long-term opioids with a validated and standardized functional assessment from 0% (N=95) pre-implementation to 63.53% (n=71). Providers endorsed the feasibility and sustainability of using the PEG assessment scale with intent to continue use after project completion.

Conclusions/Implications for Practice: Clinical staff supported utility of the PEG assessment scale despite not reaching the target average completion rate of 75%. The tool not only supports guideline compliant care but provides a more comprehensive assessment, helps open conversations about impacts of pain and goals of care, and helps direct changes in pain management regimens to support function.

Document Type