Geriatric Pain Care in the Emergency Department

描述（由申请人提供）：本申请为黄禹锡博士在急诊科（ED）开展以患者为导向的老龄化研究提供指导和培训计划。黄博士的长期职业目标是成为一名独立的研究者，专注于理解和改善急诊科老年人的疼痛管理。对与较差的疼痛护理相关的因素（包括急诊科患者相关的特征和环境条件）的评估将使黄博士能够开发和瞄准未来的干预措施，以改善老年人的疼痛管理。该奖项将为她提供数据、培训、经验和信誉，使她成为一名倡导者和领导者，促进ED中老年人护理质量的提高。这份申请详细说明了一个五年计划，包括广泛的指导、研究培训、老年医学教育活动和两个研究项目——所有这些都建立在黄博士以前的培训和目前的研究基础上。在老年病学（R. Sean Morrison博士，主要导师）和急诊医学（Lynne D. Richardson博士）两大领域的领导的指导下，她将在整个奖项期间在方法学、老龄化研究和急诊科老年人护理方面获得强有力的指导。她还将得到急诊疼痛研究方面的内容导师（Knox Todd博士）和统计导师（Gary Winkel博士）的额外支持。正式的课程将加强她在使用大数据集，利用时间数据和层次模型的生物统计方法方面的基础，并侧重于老年人的结果和统计原则。黄禹锡的教育导师（Roseanne Leipzig博士）为她量身定制的老年医学教育课程将使她能够扩大对衰老研究的知识和理解，为她提供老年人ED护理和老年急诊医学研究的老年医学专家视角。这两项拟议的应用研究相辅相成，同时建立和扩展了黄博士以前的工作。项目一的具体目标是研究患者相关特征和ED拥挤因素如何影响老年人的疼痛护理，而项目二将研究ED疼痛护理相关的短期临床结果。这两个项目都涉及与现有研究小组的合作。项目一涉及与多中心学术急诊科联盟合作研究拥挤，而项目二使用来自住院癌症患者姑息治疗结果的前瞻性多中心观察性研究的数据。这两个项目的结果将允许测试与老年人ED疼痛管理及其结果相关的几个假设。这些结果也将为评估老年人疼痛护理干预措施的主要研究提供基础。疼痛护理是评价护理质量的典型条件。调查老年人在急诊科的疼痛护理如何受到患者相关因素和急诊科环境因素的影响，并了解急诊科疼痛护理在医院护理连续性中的相关性，可以为急诊科和一般医疗保健系统的准备做出重要贡献，以关注提供高质量老年患者护理的挑战。

DESCRIPTION (provided by applicant): This application proposes a mentoring and training program for Dr. Ula Hwang in patient-oriented aging research in the emergency department (ED). The long-term career goals of Dr. Hwang are to become an independent investigator with a focus on understanding and improving pain management for older adults seen in the ED. The evaluation of factors (both patient-related characteristics and environmental conditions in the ED) associated with poorer pain care will allow Dr. Hwang to develop and target future interventions to improve pain management for older adults. This award will provide her with the data, training, experience, and credibility to become an advocate and leader for promoting better quality of care for older adults in the ED. This application details a five-year plan that includes extensive mentoring, research training, geriatrics education activities, and two research projects - all building upon Dr. Hwang's previous training and current research. Under the mentorship of leaders in both the fields of geriatrics (Dr. R. Sean Morrison, primary mentor) and emergency medicine (Dr. Lynne D. Richardson), she will receive strong guidance throughout the award period in the areas of methodology, aging research, and elder care in the ED. She will be additionally supported by a content mentor in emergency pain research (Dr. Knox Todd) and a statistical mentor (Dr. Gary Winkel). Formal coursework will strengthen her foundation in biostastitical methods using large data sets, utilizing time data and hierarchical models, and focusing on outcomes and statistical principles specific to the older adult. A geriatrics educational curriculum tailored for Dr. Hwang by her educational mentor (Dr. Roseanne Leipzig) will allow her to expand her knowledge and understanding of aging research, providing her with a Geriatrician's perspective on ED care for older adults and Geriatric-Emergency Medicine research. The two proposed studies of the application complement each other, while building and expanding on previous work by Dr. Hwang. The specific aims of Project One are to study how patient-related characteristics and ED crowding factors affect pain care for older adults, while Project Two will examine short-term clinical outcomes associated with ED pain care. Both projects involve collaborations with existing research groups. Project One involves a collaboration with a multicenter consortium of academic EDs studying crowding, while Project Two uses data from a prospective multicenter observational study of palliative care outcomes for hospitalized cancer patients. The results of both projects will permit the testing of several hypotheses related to ED pain management for older adults and its outcomes. These results will also provide the foundation from which major studies evaluating pain care interventions may be designed and targeted for the older adult. Pain care is a model condition for evaluating the quality of care. Investigating how pain care delivery for the older adult in the ED setting is affected by patient-related and ED environmental factors, and understanding the relevance of ED pain care in the continuum of hospital care can make an important contribution to preparing the ED, and the healthcare system in general, to focus on the challenges of providing high quality geriatric patient care.