ACUTE PAIN MANAGEMENT TO IMPROVE PATIENT OUTCOMES

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The aim of the proposed research is to evaluate the effectiveness of a pain management educational program, designed for nurses, physicians and pharmacists who provide perioperative care to patients. The program is designed to change perioperative chart-documentation and patient reported outcomes of pain management in community hospitals who do not have a pain management service. A multidisciplinary team of experts in pain management will travel to 6 community hospitals to present a 3-session educational program for participants who otherwise would not have the opportunity to participate in such a program. The program, which will be developed with a delphi process, will promote change in patient outcomes that are both physiological and psychological. It will address institutional obstacles to practice change, patient assessment, pharmacologic and nonpharmacologic management, and the development of hospital-based programs of continuous quality improvement. The program is unique in its emphasis on the assessment of biobehavioral factors that may modulate responses to pain; its also uses recommendations found in the AHCPR guidelines for acute pain management. Control subjects will be offered the program at the end of the data collection period. The effectiveness of the program will be measured using a 2 X 3 design with treatment levels (intervention vs control) the first factor and the assessment samples (pre-intervention, post-intervention, and follow-up) the second factor. The assessment samples at different times are independent and form a between-subjects factor. The total sample will consist of approximately 126 health care providers and 900 patients. Measurement will include a chart audit for evidence of activities in pain management and patient interviews for pain intensity, interference with activities, and relief. Multivariate models will be used to test for intervention effects.