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

项目摘要/摘要 每年，数百万儿童在紧急情况下受伤并接受侵入性医疗程序 部门(ED)。目前的指导方针强调有必要解决儿童的重大痛苦和痛苦 急诊科经验不足，但疼痛和痛苦管理不足的情况仍然普遍存在。治疗不足的疼痛和 痛苦可能会导致负面的未来疼痛体验和不适应的心理行为结果。近期 研究表明，拉丁裔儿童体验周围痛苦和疼痛的风险特别高 急诊室的手术以及疼痛治疗方面的差异。这项申请提出了一种大规模的观测， 一项纵向队列研究，以确定种族中程序性痛苦和疼痛的预测因素和结果 接受侵入性ED手术的2-9岁儿童的不同样本。方法将基于 NIMHD少数民族健康差异研究框架和三重目标，并将包括经验知识 对心理、社会文化、环境、医疗保健系统、临床康复、患者的评估 经验和资源利用变量。K23候选人是加州大学的助理教授 加州-欧文医学院，目标是建立一个独立的跨学科研究计划 这改善了儿科疼痛护理，并防止了围绕伤害的不良后果和医疗保健差异 儿科急诊室痛苦的手术。应聘者的培训计划充分利用了一位高度 经验丰富的多学科指导团队，整合有关侵袭性边缘疼痛的关键培训 程序，三重目标，基于价值的护理框架，儿童疼痛和儿科疾病的社会文化因素 医疗保健差异、高级统计建模和专业发展。此应用程序将是 在UCI压力与健康中心内执行，这是一个高效、成熟的研究环境 这结合了一种独特的多学科方法来进行培训和临床研究。培训计划将 整合教学课程、一对一指导和加州大学欧文分校临床与翻译研究所 科学(NIH CTSA)资源和研讨会侧重于职业发展、培训评估和研究 伦理道德。在奥兰治县儿童医院高层领导的热情和物质支持下， 该项目将在数量庞大的儿科急诊室进行，那里有很大比例的患者(66%)是Latinx 是创新的人口健康计划的一部分。总体而言，这将提供一种特殊的培训 描述高危人群中程序性疼痛和痛苦的多维因素的环境 体验护理差异，并启动一项具有临床影响力的独立研究计划，以促进 急诊科有效和公平的儿科疼痛和伤害相关护理。

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.