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.

项目概要/摘要 每年，数以百万计的儿童在紧急情况下受伤并接受侵入性医疗程序 部门（ED）。当前的指南强调需要解决儿童的严重疼痛和困扰 急诊室经验丰富，但疼痛和应激管理不足的情况仍然普遍存在。疼痛治疗不足和 痛苦可能会导致未来负面的疼痛经历和适应不良的心理行为结果。最近的 研究表明，拉丁裔儿童经历周围环境的痛苦和痛苦的风险特别高 急诊室的手术以及疼痛治疗差异。该应用提出了大规模观测、 纵向队列研究，以确定种族中手术困扰和疼痛的预测因素和结果 接受侵入性急诊手术的 2-9 岁儿童的不同样本。方法将基于 NIMHD 少数族裔健康差异研究框架和三重目标，并将包括基于经验的信息 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候选人是英国大学的助理教授 加州-尔湾医学院旨在建立独立的跨学科研究项目 改善儿科疼痛护理并防止不良后果和围绕伤害的医疗保健差异 以及儿科急诊室的痛苦手术。候选人的培训计划利用了高度专业知识 经验丰富的多学科指导团队，整合侵入性 ED 相关疼痛的关键培训 程序、基于价值的三重目标护理框架、儿科疼痛和儿科的社会文化因素 医疗保健差异、先进的统计模型和专业发展。该应用程序将 在 UCI 压力与健康中心内执行，这是一个高效且完善的研究环境 它结合了独特的多学科方法进行培训和临床研究。培训计划将 结合教学课程、一对一指导以及加州大学欧文分校临床和转化研究所 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。在奥兰治县儿童医院高层领导的热情和物质支持下， 该项目将在一个大容量儿科急诊室进行，其中很大一部分患者 (66%) 是拉丁裔 并且是创新人口健康计划的一部分。总的来说，这将提供特殊的培训 描述高危人群手术疼痛和痛苦的多维因素的环境 经历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 在急诊室提供有效且公平的儿科疼痛和伤害相关护理。