PRACTICE VARIATIONS IN PAIN CONTROL AT THE END OF LIFE

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This application seeks funding to pilot test a methodology for investigating patterns of analgesic pain treatment in patients with advanced cancer using health insurance claims data. Such a methodology would provide a relatively efficient way to learn more about the patterns of analgesic pain treatment in a large cross-section of the U.S. population, as well as to identify variations in the practice of pain management in population sub-groups. It would also allow us to estimate how consistently the guidelines for cancer pain management published by AHCPR in 1994 are being applied in different population groups. If successfully developed, this methodology could be used to perform further practice pattern studies in populations of interest, to evaluate the impact of pertinent regulatory changes on patient care before and after implementation, to evaluate the effect of well-treated vs. poorly-treated pain in terms of clinical outcomes, and to compare practice patterns of different health care payors, including publicly funded sources an health maintenance organizations. The proposed study will be a retrospective investigation of privately-funded insurance claims data. The specific aims of the project are: 1. To determine the feasibility of using insurance claims data for descriptive studies of analgesic pain treatment patterns. 2. To assess the concordance between insurance claims data and medical record documentation of pain treatment. 3. To determine whether there are differences in the level of pain treatment for those being treated in states with triplicate prescription programs (with tight control of opioid analgesics) compared to those in states where this is not the case. 4. To determine whether pain treatment practices differ for various population sub-groups such as members of specific minority of gender groups, and the elderly.