Racial and Ethnic Disparities in Acute Pain Control

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DESCRIPTION (PROVIDED BY APPLICANT): The long-term objective of this research is to ensure that all patients in pain who present to the Emergency Department (ED) receive appropriate pain management. Pain is the most frequent reason for ED visits in the United States. There is evidence that pain is inadequately treated in the ED, and studies in Atlanta and Los Angeles suggests that Blacks and Hispanics are less likely to receive adequate analgesia than are their white counterparts. It is not clear, however, whether these difference, observed in retrospective chart reviews at single hospitals are purely local phenomena, or whether under-treatment of pain is more broadly associated with race or ethnicity in other settings. We aim to compare pain management among three groups of ED patients. Hispanics, non-Hispanic, Black, non-Hispanic Whites, and to assess whether the observed association between pain management and race/ethnicity is independent of confounding variable such as age, sex, insurance status, education. We also aim to assess whether the effect of race/ethnicity on adequacy of pain management is explained by (patient initial pain intensity) or by discordance between patients' and physicians': 1) race/ethnicity, b) physicians' perception of patient's pain. To do this (285) patients with long-bone fractures will be recruited in the EDs of one municipal and one voluntary hospital serving an inner-city, disadvantaged population in the Bronx. Data will be collected on pain using self-reported pain [and non-verbal pain expressions] at baseline, one hour post-baseline, and at discharge. Data on analgesics administered, patient and physician characteristics will also be gathered. [We plan to conduct a chart review of long fractures in 2000 and 2001 in order to analyze the association between race/ethnicity and pain management using the same design as all previously published studies. Comparison of the retrospective and prospective results will strengthen inferences that can be drawn from our findings.] Prospective quantification of disparities in acute pain management in ED's, which are the interface between the population and the health care system in times of crisis, and defining predictors of undertreatment of pain will enable health care providers to improve quality of care by developing guidelines for acute pain management in the ED.