Identifying Pain Trajectories In Sickle Cell Disease Using Latent Class Analysis

使用潜在类别分析识别镰状细胞病的疼痛轨迹

• 批准号: 9299186
• 负责人: Angie Mae Rodday
• 金额: $ 26.25万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-23 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9299186
• 关键词: Academic Medical Centers; Accounting; Acute; Admission activity; Adult; Affect; African; African American; Anti-Inflammatory Agents; Anti-inflammatory; Asian Indian; Avascular necrosis of bone; Clinical; Communication; Disease; Emergency department visit; Erythrocytes; Ethnic Origin; European; Future; Goals; Health Care Costs; Health Services Accessibility; Healthcare; Hematological Disease; Hemolytic Anemia; Heritability; Hispanics; Home environment; Hospitalization; Individual; Inpatients; Insurance Coverage; Intervention; Low income; Measures; Methodology; Minority Groups; Morbidity - disease rate; Numeric Rating Scale; Opioid; Outcome; Outpatients; Overdose; Pain; Pain Measurement; Pain intensity; Pain management; Patient Outcomes Assessments; Patient risk; Patients; Pattern; Perception; Pharmaceutical Preparations; Pneumonia; Postoperative Pain; Prevalence; Prospective Studies; Provider; Race; Recruitment Activity; Reporting; Retrospective cohort; Risk; Septicemia; Severity of illness; Sickle Cell; Sickle Cell Anemia; Signal Transduction; Statistical Methods; Techniques; Variant; acute chest syndrome; addiction; body system; cancer pain; clinical care; drug addict; ethnic minority population; exhaust; experience; health care disparity; health care service utilization; health related quality of life; high risk; improved; innovation; mortality; patient home care; prospective; racial and ethnic disparities; racial minority; treatment strategy

PROJECT SUMMARY/ABSTRACT Sickle cell disease (SCD) is a group of heritable red blood cell disorders that primarily affect individuals who identify as Black or African-American. Other affected groups include those of Hispanic, southern European, Middle Eastern, and Asian Indian descent. The hallmark of SCD is the painful vaso-occlusive crisis (VOC), which is still not well understood or managed. This may result in delays in treatment, undertreatment, and unnecessary suffering. Because SCD primarily affects African-Americans and other minority groups, mistrust between patients and providers may put patients with SCD at increased risk of healthcare disparities, including reduced access to necessary pain management. For most patients, pain is managed at home, further contributing to underestimation by healthcare practitioners of the prevalence and impact of SCD pain. However, when patients in VOC present acutely, they have usually exhausted home care and outpatient therapies, thereby signaling the need for parenteral opioids. Using a retrospective cohort of 150 patients with SCD hospitalized at one urban academic medical center, the overall goal of this study is to develop methodology to characterize the sickle cell pain trajectory. Specifically, the aims are to (1) use latent class analysis to identify different patterns of pain trajectories during hospitalizations for sickle cell pain crisis and determine socio-demographic and clinical factors associated with the different pain trajectories; (2) describe the relationship between treatment management strategies and sickle cell pain scores during hospitalization; and (3) assess the relationship between different patterns of sickle cell pain trajectories and future readmission for sickle cell pain crisis. Results from the proposed study can then be used to develop prospective studies to better measure pain during hospitalizations or to identify factors that affect the pain trajectory, which can be used to target interventions or pain management approaches. In addition, better characterization of the pain trajectory and treatment of pain in SCD are especially urgent as efforts are made nationally to restrict access to opioids given the current crisis of abuse, addiction, and overdose. Patients experiencing severe and devastating pain, such as those with SCD, should not be made to suffer because they are denied necessary treatment.

项目摘要/摘要 镰状细胞病（SCD）是一组可遗传的红细胞疾病，主要影响个人 确定为黑人或非裔美国人。其他受影响的群体包括西欧西班牙裔的群体 中东和亚洲印度血统。 SCD的标志是痛苦的血管熟悉危机（VOC）， 仍然不太了解或管理。这可能导致治疗，治疗不足和 不必要的痛苦。因为SCD主要影响非裔美国人和其他少数群体，所以不信任 在患者和提供者之间，可能会使患有SCD患者的医疗保健差异风险增加，包括 减少了获得必要的疼痛管理。对于大多数患者而言，在家里进行疼痛，进一步治疗 有助于受到SCD疼痛的患病率和影响的医疗保健从业者的低估。 但是，当VOC中的患者急性表现时，他们通常会用尽家庭护理和门诊病人 疗法，从而信号表明需要肠胃外阿片类药物。使用150例患者的回顾性队列 SCD在一个城市学术医学中心住院，这项研究的总体目标是开发 表征镰状细胞疼痛轨迹的方法。具体而言，目的是（1）使用潜在类 分析以确定镰状细胞疼痛危机住院期间的疼痛轨迹模式的不同模式 确定与不同疼痛轨迹相关的社会人口统计学和临床​​因素； （2）描述 住院期间治疗管理策略与镰状细胞疼痛评分之间的关​​系； （3）评估镰状细胞疼痛轨迹不同模式与未来再入院之间的关系 用于镰状细胞疼痛危机。然后，拟议研究的结果可用于开发前瞻性研究 更好地测量住院期间的疼痛或确定影响疼痛轨迹的因素，这可能是 用于针对干预措施或疼痛管理方法。另外，更好地表征疼痛 SCD中的轨迹和疼痛的治疗尤其紧急，因为在全国范围内努力限制进入 阿片类药物鉴于当前的虐待，成瘾和过量危机。患者经历严重和 毁灭性的疼痛，例如患有SCD的疼痛，不应遭受痛苦，因为它们被拒绝了 治疗。