Enhancing Geriatric Pain Care with Contextual Patient Generated Profiles

背景：疼痛不是衰老过程中不可避免的或正常的部分。然而，老年患者的慢性疼痛是 广泛存在，在大约50%的65岁或以上的社区居住成年人中发生。治疗不力 慢性疼痛患者面临生活质量下降和功能下降的风险。阿片类药物成瘾的风险 对老年疼痛患者的止痛处方日益得到认可。有证据表明，疼痛在 老年病患者很常见，评估具有挑战性，需要全人诊断， 治疗和监测。本研究的目标是改进和测试一种创建情景患者的方法 生成的数据(PGD)配置文件，以指导老年疼痛护理。 意义/影响：我们建议的工作将有助于有效的疼痛管理和患者的交付 集中护理。拟议的工作符合退伍军人管理局的许多高度优先领域，包括老年退伍军人、 疼痛管理、信息学和整体健康，并对电子产品的重新设计产生影响 健康记录(EHR)。 创新：这项研究包括一种通过检查背景PGD来实现以患者为中心的创新方法 对患有慢性疼痛的脆弱退伍军人群体的深入贡献。 具体目标： 目标1：为相关的PGD简介确定优先顺序，以支持以患者为中心的老年退伍军人护理 伴随着慢性疼痛。 目的2：开发一个原型的情景PGD显示器并评估其可用性。 目标3：检查上下文PGD配置文件显示对患者依从性、满意度和共享的影响- 随机试验中的决策。 方法：研究人群是患有慢性疼痛的退伍军人，参与他们日常生活的照顾者，以及 在城市和城市的初级保健或老年诊所治疗这些退伍军人的初级保健临床医生 乡村环境。临床医生将包括医生、执业护士、护士、社会工作者、心理学家和 其他相关的初级保健团队成员。这是一项混合方法研究，将焦点小组和 临床医生和资深患者和照顾者以及系统地评估迭代贡献 情景PGD为退伍军人制定和优化方法，以贡献情景PGD。此外，VHA 初级保健和老年病诊所的临床医生将参加名义上的团体技术，他们将在该技术中 回顾相关的PGD要素，并就这些要素对其临床医生角色的重要性进行投票 一般用于患者的疼痛管理护理。另一组PACT成员将参与 更详细地报告特定上下文PGD元素的相关性的卡片分类。将会有一个 在患者水平上的随机比较，比较包括背景PGD和 但事实并非如此。主要结果包括图表中记录的临床决策的适当性和 由专家临床医生进行评级，并在随访时评估患者对疼痛管理的满意度。 次要成果包括访问中的共同决策。 下一步/实施：我们的项目包括多项评估，旨在改善收集 为未来的实施提供信息，与我们的业务合作伙伴密切合作 医疗信息学、互联医疗和以患者为中心的医疗与文化转型。

Background: Pain is not an inevitable or normal part of aging. However, chronic pain for geriatric patients is widespread, occurring in approximately 50% of community dwelling adults age 65 or over. Ineffectively treated chronic pain patients are at risk for poorer quality of life and functional decline. Risk for addiction to opioids prescribed for pain are increasingly recognized for geriatric pain patients. Evidence suggests that pain in geriatrics patients is common, challenging to assess, and requires a whole-person approach to diagnosis, treatment and monitoring. The goal of this study is to refine and test an approach to create contextual Patient Generated Data (PGD) profiles to guide geriatric pain care. Significance/Impact: Our proposed work will contribute to effective pain management and delivery of patient centered care. The proposed work aligns with many areas of high priority for VA including aging Veterans, pain management, informatics, and whole health and has implications for the redesign of the Electronic Health Record (EHR). Innovation: This study includes an innovative approach to patient centered care by examining contextual PGD contribution in depth in a vulnerable Veteran population with chronic pain. Specific Aims: Aim 1: Prioritize content for contextual PGD profiles to support patient-centered care for geriatric Veterans with chronic pain. Aim 2: Develop a prototype contextual PGD display and evaluate its usability. Aim 3: Examine the impact of contextual PGD profile displays on patient adherence, satisfaction, and shared- decision making in a randomized trial. Methodology: The study population is Veterans with chronic pain, caregivers involved in their daily lives, and the primary care clinicians who treat these Veterans in primary care or geriatrics clinics in both urban and rural settings. Clinicians will include physicians, nurse practitioners, nurses, social workers, psychologists and other relevant primary care team members. This is a mixed methods study incorporating focus groups with clinicians and with Veteran patients and caregivers and systematic evaluation of iterative contributions of contextual PGD to develop and optimize methods for Veterans to contribute contextual PGD. In addition, VHA clinicians in primary care and geriatrics clinics will participate in a nominal group technique in which they will review contextual PGD elements and vote on how important these elements are for their role as a clinician and in general for the patients’ pain management care. An additional group of PACT members will engage in a card sort reporting in more detail on the relevance of particular contextual PGD elements. There will be a randomized comparison at the patient level comparing patient visits that include contextual PGD and those that do not. Primary outcomes include appropriateness of clinical decisions documented in the chart and rated by expert clinicians and an assessment of patient satisfaction with pain management at follow up. Secondary outcomes include shared decision making in the visit. Next Steps/Implementation: Our project includes multiple assessments designed to improve collection of contextual PGD to inform future implementation, working closely with our operational partners the Offices of Healthcare Informatics, Connected Care and Patient Centered Care and Cultural Transformation.