Improving management of acute pain for older adults in the ED setting

改善急诊室老年人急性疼痛的管理

基本信息

批准号：
8301883
负责人：
Ula Y Hwang
金额：
$ 25.25万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-05-01 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8301883
关键词：
Abdominal Pain Absence of pain sensation Accident and Emergency department Acute Acute Pain Address Age Algorithms Analgesics Area Awareness Caring Client satisfaction Clinical Computerized Medical Record Data Documentation Elderly Electronics Emergency Medicine Emergency Situation Evaluation Goals Informatics Inpatients Intervention Methods Multicenter Studies Nurses Observational Study Outcome Outpatients Pain Pain Measurement Pain quality Patients Pharmaceutical Preparations Pilot Projects Population Process Quality Indicator Quality of Care Randomized Recording of previous events Research Research Design Research Methodology Research Personnel Sampling Site Testing Work arm care delivery clinical care comparative effectiveness compare effectiveness effectiveness trial improved information gathering innovation older patient patient population routine care success tool usability

项目摘要

DESCRIPTION (provided by applicant): As the population ages, an increasing number of older adults will present to emergency departments (EDs) for urgent and painful conditions. Preliminary studies demonstrate that older adults are less likely to receive analgesia in the ED setting. Over the last decade, pain care interventions in the outpatient and inpatient settings have had mixed success in improving the quality and patient satisfaction of pain care received. Interventions that provide clinical decision support (CDS) are a potential method to overcome this barrier and may present new assessment methods and management strategies for treating acute pain in older adults, thus significantly improve the quality of pain care delivered. The goals of this exploratory pilot study are to determine the feasibility of integrating electronic clinical decision support into routine clinical pain care for older adults in the ED setting and to determine whether or not such clinical decision support is efficacious in improving pain care outcomes for these patients. Utilizing a multistage study design that incorporates usability testing and quantitative research methodologies, data will be collected to assess the feasibility of integrating a CDS tool consisting of both an electronic pain care alert (ePCA) intervention and an embedded pain care algorithm into routine ED clinical care. A randomized comparative effectiveness trial evaluating the efficacy of these will then be studied to determine if the intervention improves the quality of pain care. The innovative use of CDS, never previously used to improve geriatric pain care in the ED setting, to prompt clinicians to provide acute pain care to older patients with complaints of severe (abdominal) pain (pain score 10 out of 0-10 pain scale) will be compared to control patients seen by clinicians not receiving the alerts (routine ED care). If effective, the implications of such an intervention will have broad implications and applicability for other acute pain-associated conditions specific to older adults, and with urgent conditions seen in multiple settings across and external to the ED including inpatient and outpatient settings. PUBLIC HEALTH RELEVANCE: This exploratory study will evaluate the innovative use of a clinical decision support tool that consists of an automated electronic pain care alert and embedded pain care algorithms to improve acute pain care for older adults in the ED setting. If feasible and effective, such an intervention may have broad implications on improving not only the quality of geriatric pain care, but also general quality of care for elders in the ED setting.

描述（由申请人提供）：随着人口老龄化，越来越多的老年人因紧急和痛苦的情况而前往急诊科 (ED)。初步研究表明，老年人在急诊室接受镇痛的可能性较小。在过去的十年中，门诊和住院患者的疼痛护理干预措施在提高疼痛护理的质量和患者满意度方面取得了不同程度的成功。提供临床决策支持（CDS）的干预措施是克服这一障碍的潜在方法，并可能为治疗老年人急性疼痛提供新的评估方法和管理策略，从而显着提高疼痛护理的质量。这项探索性试点研究的目标是确定将电子临床决策支持整合到急诊室老年人的常规临床疼痛护理中的可行性，并确定此类临床决策支持是否能有效改善这些患者的疼痛护理结果。利用结合可用性测试和定量研究方法的多阶段研究设计，将收集数据以评估将由电子疼痛护理警报 (ePCA) 干预和嵌入式疼痛护理算法组成的 CDS 工具集成到常规 ED 临床护理中的可行性。然后将研究评估这些效果的随机比较效果试验，以确定干预措施是否可以提高疼痛护理的质量。 CDS 的创新用途以前从未用于改善急诊室的老年疼痛护理，促使临床医生为主诉严重（腹部）疼痛（疼痛评分为 10 分，满分 0-10 疼痛量表）的老年患者提供急性疼痛护理将与未收到警报的临床医生看到的对照患者进行比较（常规 ED 关心）。如果有效，这种干预措施将对老年人特有的其他急性疼痛相关病症以及急诊室内外多种环境（包括住院和门诊环境）中出现的紧急情况产生广泛的影响和适用性。公共健康相关性：这项探索性研究将评估临床决策支持工具的创新使用，该工具包括自动电子疼痛护理警报和嵌入式疼痛护理算法，以改善急诊室老年人的急性疼痛护理。如果可行且有效，这种干预措施不仅可以改善老年疼痛护理的质量，而且可以改善急诊室老年人的总体护理质量。