A Decision Support Tool for Adult Sickle Cell Emergency Department Patients

描述(由申请人提供)： 申请者是西北大学急诊医学研究助理教授。申请者的长期目标是成为一名独立的调查员，主要专注于改善急诊科(ED)环境下对镰状细胞病(SCO)患者的护理。急性疼痛发作是SCD最常见的并发症。这些痛苦的发作是严重的，通常需要在急诊科(ED)环境下护理。ED临床医生经常认为患有SCD的人是在寻求药物，而患者经常认为ED的经历令人沮丧。一些SCD患者也有复杂的共病和生物-心理-社会需求，这可能是导致频繁就诊急诊室的原因之一。临床医生通常没有准备好处理SCD患者在急诊环境中的急性疼痛，也没有接受过如何进行充分的生物-心理-社会评估的培训，以确定急诊出院时个别患者的教育和转诊需求。确定这些需求可能会改善护理，并在得到适当的转诊后减少急诊室的回访。该项目的目标是开发和试点测试一种生物-心理-社会决策支持工具(需求和力量的镰刀细胞评估，扫描)，供急诊临床医生使用。这些扫描将1)客观地评估和指导ED止痛治疗，2)确定SCD成年患者的教育和转诊服务交付需求。这些扫描将对急诊医生和SCD患者都有好处，特别是对于目前可能导致频繁急诊的复杂需求的患者。在血液学、急救医学、疼痛管理、心理测量学和成瘾等领域的资深研究人员的指导下，应聘者提出了一个职业发展计划，以满足申请者成为一名独立调查员的长期目标。拟议培训的主要目标是1)增加SCD方面的知识，2)深入了解成瘾和疼痛之间的复杂关系，3)接受定性和决策支持工具开发方法方面的培训。这些知识将使候选人能够作为一名调查员开始研究生涯，他将开展旨在科学评估机制的项目，以改善急诊室对SCD患者的护理。

DESCRIPTION (provided by applicant): The applicant is a Research Assistant Professor in Emergency Medicine at Northwestern University. The applicant's long-term goal is to become an independent investigator with a primary focus on improving the care for persons with Sickle Cell disease (SCO) in the emergency department (ED) setting. Acute pain episodes are the most frequent complication associated with SCD. These painful episodes are severe and often require care in the emergency department (ED) setting. ED clinicians frequently perceive persons with SCD to be drug seeking and patients often perceive the ED experience as frustrating. Some patients with SCD also have complex co-morbidities and bio-psycho-social needs that may contribute to frequent ED visits. Clinicians are often unprepared to manage the acute pain in the ED setting for persons with SCD and are not trained in how to perform an adequate bio-psycho-social assessment that would identify individual patient education and referral needs upon ED discharge. Identification of these needs may lead to improved care and decreased return ED visits when provided with proper referrals. The goal of this project is to develop and pilot test a bio-psycho-social decision support tool (the Sickle Cell Assessment of Needs and Strengths, SCANS) to be used by emergency clinicians. The SCANS will 1) objectively assess and guide ED analgesic management and 2) identify education and referral service delivery needs for adult patients with SCD. The SCANS will be beneficial to both emergency clinicians and patients with SCD, in particular for patients with complex needs that currently may result in frequent ED visits. Under the mentorship of established investigators in the areas of hematology, emergency medicine pain management, psychometrics and addiction the candidate proposes a career development program that addresses the applicants' long- term goal of becoming an independent investigator. Primary goals of the proposed training are to 1) increase knowledge in SCD, 2) gain an in-depth understanding of the complex relationship between addiction and pain, and 3) receive training in qualitative and decision support tool development methodologies. This knowledge will position the candidate to launch a research career as an investigator who will conduct projects aimed at scientifically evaluating mechanisms to improve the care of persons with SCD in the ED setting.