Pain in children: clinical, patient experience, and resource utilization outcome disparities surrounding invasive emergency department procedures

儿童疼痛：侵入性急诊科手术的临床、患者体验和资源利用结果差异

• 批准号: 10525863
• 负责人: Sarah R Martin
• 金额: $ 16.76万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10525863
• 关键词: 9 year old; Accident and Emergency department; Address; Adult; Affect; Analgesics; Anxiety; Awareness; Behavioral; California; Caring; Child; Child Support; Childhood; Client satisfaction; Clinical; Clinical Research; Clinical Sciences; County; Critical Illness; Development; Distress; Emergency department visit; Environment; Evaluation Research; Future; General Population; Guidelines; Health; Health Disparities Research; Healthcare Systems; Injury; Institutes; Interdisciplinary Study; Intervention; Latinx; Latinx population; Leadership; Length of Stay; Literature; Longitudinal cohort study; Medical; Mentors; Mentorship; Methods; National Institute of Child Health and Human Development; National Institute on Minority Health and Health Disparities; Needles; Operative Surgical Procedures; Oranges; Outcome; Pain; Pain management; Patient-Centered Care; Patients; Pattern; Pediatric Hospitals; Pharmaceutical Preparations; Policies; Population; Populations at Risk; Procedures; Provider; Recovery; Research; Research Ethics; Research Priority; Resources; Risk; Sampling; Social Values; Statistical Models; Stress; Training; Translational Research; United States National Institutes of Health; Universities; Vulnerable Populations; Wait Time; Work; adverse outcome; base; behavioral outcome; bone fracture repair; care costs; career development; effective therapy; ethnic diversity; experience; health care disparity; high risk; improved; improved outcome; innovation; interdisciplinary approach; medical schools; minority health disparity; multidisciplinary; neighborhood disadvantage; outcome prediction; pain outcome; pediatric emergency; pediatric trauma; population health; prevent; procedural pain; professor; programs; psychologic; psychological outcomes; satisfaction; social culture; trait; treatment disparity

PROJECT SUMMARY / ABSTRACT Each year, millions of children sustain injuries and undergo invasive medical procedures in the emergency department (ED). Current guidelines emphasize the need to address the significant pain and distress children experience in the ED, but inadequate pain and distress management remain prevalent. Under-treated pain and distress can result in negative future pain experiences and maladaptive psycho-behavioral outcomes. Recent work suggests that Latinx children are at a particularly high risk for experiencing distress and pain surrounding surgery as well as pain treatment disparities in the ED. This application proposes a large-scale observational, longitudinal cohort study to identify both predictors and outcomes of procedural distress and pain in an ethnically diverse sample of children 2-9 years old undergoing invasive ED procedures. Methods will be based on the NIMHD Minority Health Disparities Research Framework and Triple Aim and will include empirically informed assessments of psychological, sociocultural, environmental, healthcare system, clinical recovery, patient experience, and resource utilization variables. The K23 candidate is an Assistant Professor at the University of California-Irvine School of Medicine and aims to establish an independent interdisciplinary research program that improves pediatric pain care and prevents adverse outcomes and healthcare disparities surrounding injury and painful procedures in the pediatric ED. The candidate’s training plan capitalizes on the expertise of a highly experienced multidisciplinary mentorship team, integrating key training in pain surrounding invasive ED procedures, Triple Aim value-based care framework, sociocultural factors in pediatric pain and pediatric healthcare disparities, advanced statistical modeling, and professional development. This application will be executed within the UCI Center on Stress & Health, a highly productive, well-established research environment that incorporates a unique multidisciplinary approach to training and clinical research. The training plan will incorporate didactic coursework, one-on-one mentoring, and UC Irvine Institute for Clinical and Translational Science (NIH CTSA) resources and seminars focused on career development, training evaluation and research ethics. With enthusiastic and material support from the Children’s Hospital of Orange County senior leadership, the project will be conducted in a high-volume pediatric ED where a large proportion of patients (66%) are Latinx and are part of an innovative population health program. Collectively, this will provide an exceptional training environment to characterize multidimensional contributors to procedural pain and distress in a population at-risk for experiencing care disparities and launch a clinically impactful, independent research program that promotes effective and equitable pediatric pain and injury-related care in the ED.

项目摘要 /摘要 每年，数以百万计的儿童在出现中受伤并接受医疗程序 部门（ed）。当前的指南强调需要解决重大痛苦和困扰儿童 在急诊室的经验，但疼痛和痛苦管理不足仍然很普遍。处理不足的疼痛和 困扰会导致未来的负面疼痛经历和适应不良的心理行为结果。最近的 工作表明，拉丁裔儿童面临着遇到困扰和痛苦的风险 ED中的手术以及疼痛治疗差异。该申请提出了一个大规模观察， 纵向队列研究，以识别种族困扰和痛苦的预测因素和结果 2-9岁儿童的不同样本正在接受侵入性的手术。方法将基于 NIMHD少数民族健康差异研究框架和三重目标，并将包括经验知情 评估心理，社会文化，环境，医疗保健系统，临床恢复，患者 经验和资源利用变量。 K23候选人是大学的助理教授 加利福尼亚 - 艾尔文医学院和旨在建立独立的跨学科研究计划 这可以改善小儿疼痛护理，并防止围绕伤害的不良结果和医疗保健分配 和小儿Ed中的痛苦程序。候选人的培训计划利用了高度的专业知识 经验丰富的多学科指导团队，将围绕入侵ED的疼痛的关键培训整合在一起 程序，基于三重的基于价值的护理框架，小儿疼痛中的社会文化因素和小儿 医疗保健分布，高级统计建模和专业发展。此申请将是 在UCI压力与健康中心内执行，这是一个高产，建立良好的研究环境 这结合了一种独特的多学科培训和临床研究方法。培训计划将 合并的教学课程，一对一的心理和加州大学尔湾分校临床和翻译学院 科学（NIH CTSA）资源和半货人，专注于职业发展，培训评估和研究 伦理。在奥兰治县高级领导儿童医院的热情和物质支持下， 该项目将在大量的儿科ED中进行，其中很大一部分患者（66％）是拉丁裔 是创新人口健康计划的一部分。总体而言，这将提供出色的培训 环境表征人口危险中的程序痛苦和困扰的多维贡献者 用于体验护理分布并启动临床有影响力的独立研究计划，以促进 ED中有效且公平的小儿疼痛和与伤害有关的护理。