Computerized PAINRelievelt for Adult Sickle Cell Disease

描述(申请人提供)：未缓解的镰状细胞病(SC)疼痛是一个主要的健康问题，部分归因于疼痛评估困难和缺乏已知的有效止痛药的知识。我们提出了一项两阶段纵向研究，测试三种有效和可靠的触摸屏计算机化工具：a)疼痛评估数据收集和总结报告(PAINReportlt)；b)针对患者SC疼痛管理误解量身定做的多媒体患者教育(PainUCope)；以及c)为临床医生提供决策支持，以根据患者的疼痛量身定制基于算法的止痛疗法(PAINConsultN)。这三个项目加在一起被称为PAINRelievelt。在随机临床试验的第一阶段，我们将对在DIG镰刀细胞诊所接受护理的250名患者进行测试前/测试后设计，以比较常规护理和PAINReportlt/PainUCope对a)患者结果(对疼痛、止痛剂依从性和疼痛强度的误解)的影响；以及b)门诊提供者结果(疼痛记录)。我们假设，在干预三个月后，计算机化的PAINReportlt/PainUCope组将减少误解和疼痛强度，增加止痛药的依从性，并在医疗记录中记录疼痛。在第二阶段，我们将在相同的250名镰状细胞患者中使用纵向重复测量设计来比较随机分配他们的主治急诊医生或住院医生到常规护理或PAINReportlt/PAINConsultN的效果。我们将比较常规护理和PAINReportlt/PAINConsultN对a)250名有痛苦SC危机的急诊就诊或住院风险患者的患者结果(疼痛发作)；b)34名UIC ED和住院医生的ED或住院提供者结果(疼痛记录；处方止痛药的适当性)；以及c)系统结果(ED就诊次数和痛苦SC危机住院天数)的长期影响。我们假设，在实施干预措施两年后，PAINReportlt/PAINConsultN小组将报告：a)疼痛发作减少；b)医疗记录中的疼痛记录增加，适当止痛药处方的数量增加；c)急诊次数和住院天数减少。研究结果将指导这一创新在全美的SC护理中的大规模实施。

DESCRIPTION (provided by applicant): Unrelieved sickle cell disease (SC) pain is a major health problem attributed in part to pain assessment difficulties and to lack of knowledge about analgesics known to be effective for pain control. We propose a two-phase longitudinal study testing three valid and reliable touch screen computerized tools: a) pain assessment data collection and summary report (PAINReportlt); b) multimedia patient education tailored to the patient's SC pain management misconceptions (PainUCope); and c) decision support for clinicians to prescribe algorithm-based analgesic therapies tailored to the patient's pain (PAINConsultN). Together, the three programs are known as PAINRelievelt. In the first phase of the randomized clinical trial, we will use a pre-test/post-test design in 250 patients receiving care at the DIG Sickle Cell Clinic to compare the effects of usual care and PAINReportlt/PainUCope on a) patient outcomes (misconceptions about pain, analgesic adherence, and pain intensity); and b) an outpatient provider outcome (pain documentation). We hypothesize that, three months after the intervention, the computerized PAINReportlt/PainUCope group will have decreased misconceptions and pain intensity and increased analgesic adherence, pain documentation in the medical record. In the second phase, we will use a longitudinal, repeated-measures design in the same 250 sickle cell patients to compare the effects of randomly assigning their attending ED or inpatient physicians to usual care or PAINReportlt/PAINConsultN. We will compare usual care and PAINReportlt/PAINConsultN for long-term effects on a) patient outcome (pain episodes) in 250 patients at risk for ED visits or hospitalization with painful SC crisis; b) ED or inpatient provider outcomes (pain documentation; appropriateness of prescribed analgesics) in 34 UIC ED and inpatient physicians; and c) system outcomes (number of ED visits and hospital days for painful SC crisis). We hypothesize that, two years after the intervention is implemented, the PAINReportlt/PAINConsultN group will report: a) decreased pain episodes; b) increased pain documentation in the medical record and number of appropriate analgesic prescriptions; and c) decreased number of ED visits and hospital days. Findings will guide large-scale implementation of this innovation in SC care throughout the USA.