Multifaceted Interventions to Ameliorate Pain/Symptoms

描述（由申请人提供）：疼痛仍然是疗养院中体弱老年人发病的重要原因。高达83%的养老院居民抱怨疼痛。通常，养老院居民的疼痛投诉没有得到承认或适当的治疗。大量的科学证据基础证明了治疗疼痛的现成药理学和非药理学方式。利用持续质量改进的研究，包括最近完成的老年学和医疗保健研究中心与RI质量合作伙伴合作的研究，影响了护士在评估，记录和使用非药物治疗疼痛方面的行为。这项研究导致疼痛减少了33%。然而，我们的干预并没有显着影响医生禁止的行为。根据护理协调员的报告和其他研究，护医沟通和医生知识的缺乏是两个重要的障碍，以适当的疼痛管理。在这个R21应用程序中，我们建议开发和试点测试的个人数字助理（PDA）为基础的决策支持干预疼痛管理在长期护理。该决策支持将帮助护士进行疼痛评估，提供治疗建议，并打印总结报告以固定到医生办公室。将利用美国老年学会、美国医学主任协会和AHRQ疼痛管理指南的现有指南以及专家小组的建议来制定决策支持工具。在开发这种干预措施时，我们将与最终用户（长期护理护士和医生）进行焦点小组讨论，利用认知测试，并进行为期六个月的试点测试，以检查RI的两家疗养院（一家学术基地NH和一家社区基地NH）中决策支持应用程序的使用情况。评价将收集关于决策建议时间、PDA应用的可接受性、是否使用建议以及使用决策支持前后报告的疼痛水平的信息。如果我们成功地开发了这种干预措施，将准备R01研究申请，以进行一项区组随机试验，研究这种干预措施与快速周期持续质量改进干预措施相结合是否能提高疼痛管理的质量。

DESCRIPTION (provided by applicant): Pain remains an important cause of morbidity for frail, older persons in nursing homes. As high as 83% of nursing home residents voice complaints of pain. Often, nursing home residents' complaints of pain are not recognized or not appropriately treated. A substantial scientific evidence base attests to readily available pharmacological and non-pharmacological modalities to treat pain. Research utilizing continuous quality improvement, including a recently completed study by Center for Gerontology and Health Care Research in cooperation with RI Quality Partners, has impacted on nurses' behavior in the assessment, documentation, and the use of non-pharmacological treatment of pain. This study resulted in 33% reduction in pain. However, our intervention did not significantly impact on physician proscribing behavior. Based on debriefing of nurse coordinators and others research, nurse-physician communication and physicians' lack of knowledge are two important barriers to appropriate pain management. In this R21 application, we propose to develop and pilot test a Personal Digital Assistant (PDA) based decision support intervention for pain management in long term care. This decision support will assist the nurses in conducting a pain assessment, provide treatment recommendation(s), and print a summary report to be fixed to the physician office. Existing guide lines from the American Geriatric Society, American Medical Director Association, and AHRQ pain management guidelines as well as the advice of expert panel will be utilized to formulate decision support tool. In the development of this intervention, we will conduct focus groups with end users (long term care nurses and physicians), utilize cognitive testing, and conduct a six month pilot test that will examine the use of the decision support application in two nursing homes in RI (one academic base NH and one community base NH). An evaluation will collect information on the time to decision recommendation, acceptability of the PDA application, whether recommendations were utilized, and the reported level of pain prior to and after the use of decision support. If we are successful in development of this intervention, a R01 research application will be prepared to conduct a block randomized trial of whether this intervention when combined with the rapid cycle continuous quality improvement intervention improves quality of pain management.