Due to the high steady volume of orthopedic specialty requests for the “Gateway to Better Health” program since its inception in 2012, the St. Louis Regional Health Commission (RHC) commissioned an orthopedic referral analysis in August 2016. The corresponding report, Orthopedic Referral Study: Assessment of Current Practices and Recommendations Regarding the Care of Patients with Musculoskeletal Problems, was approved by the RHC in August 2017. Key findings included the high prevalence of musculoskeletal chronic pain (pain duration >3 months) and the multifaceted opportunities to improve chronic pain treatment and prevention for patients in the St. Louis safety network. This view was strongly shared by all stakeholders interviewed, including: patients, primary care providers, orthopedic surgeons, physical therapists, pain management specialists, clinical operations staff, Gateway Operations team members, and RHC Advisory Boards.

In November 2017, the RHC’s two Advisory Boards came to the consensus that chronic pain is an important regional public health issue, voting to prioritize this topic in 2018-2019. The RHC subsequently approved chronic pain as a key focus area, with the following four deliverables: implementation plan, policy statement, communication plan, and evaluation design. For more information on the deliverables, see the Chronic Pain Initiative Work-plan. To learn more about the study, please contact Amanda Harris (aharris@stlrhc.org).