Effective Screening for Pain Study

疼痛研究的有效筛查

• 批准号: 8397641
• 负责人: Karl Lorenz
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8397641
• 关键词: Absence of pain sensation; Accounting; Acute; Address; Adherence; Age; Back; Brief Pain Inventory; Caring; Chronic; Client satisfaction; Clinic; Clinical; Comorbidity; Computer Assisted; Computers; Degenerative polyarthritis; Detection; Development; Dimensions; Disabled Persons; Documentation; Eating; Effectiveness; Eligibility Determination; Emotional; Evaluation; Face; Focus Groups; Health; Healthcare; Information Systems; Interview; Laboratories; Link; Measurement; Measures; Methodology; Methods; Numeric Rating Scale; Nursing Staff; Outcome; Outpatients; Pain; Pain Measurement; Pain intensity; Pain management; Patient Outcomes Assessments; Patients; Physical Function; Postoperative Period; Primary Health Care; Process; Protocols documentation; Provider; Randomized Controlled Trials; Reporting; Research; Risk; Role; Self-Administered; Site; Structure; Surveys; Symptoms; Testing; Veterans; arm; base; chronic pain; clinically significant; computer human interaction; demographics; disability; experience; functional disability; health record; improved; insight; medical specialties; multidisciplinary; satisfaction; screening; skills; touchscreen; usability

DESCRIPTION (provided by applicant): Objectives: The overall objective of our mixed method study is to evaluate a strategy to improve the quality and clinical usefulness of 'the 5th Vital Sign' in VA primary care. We will formatively evaluate experiences with and implementation of the enhanced pain screening approaches (patient self administered computer aided) including clinician perspectives on the use of pain screening to guide management. Our specific aims are to: Aim 1. Characterize primary care team perspectives on enhanced pain screening approaches compared with usual pain screening re., clinical usefulness and how to use skills, roles, and tasks of multidisciplinary clinicians and consultants to optimize pain care. Interviews will inform development of the screening interface we will evaluate the interface including the PEG and 'NRS now' in a human-computer interaction laboratory. Aim 2. Evaluate in a three-arm RCT the effects of enhanced pain screening approaches using the PEG (Arm 1), the 'NRS pain now' (Arm 2), compared with usual clinician-assessed pain screening (Arm 3), on (Aim 2a) the detection of patient pain at one week and (Aim 2b) feasibility, acceptability, and experiences with (e.g., pain missingness, bystander completion rates, patient and staff experiences and satisfaction) patient-reported computer-aided pain assessment using quantitative patient screening outcomes, an d interviews with patients, clinic and facility staff Research Plan: At three sites (VA GLA, Indianapolis, and Portland) we will conduct interviews with primary care staff about their experiences with pain screening and how to link screening to management in order to inform development of an integrated enhanced pain screening approach (using PEG and NRS now) on a touchscreen together with survey questions on Veteran demographics, co-morbidity, and risk for under-assessed pain. The integrated protocol will be installed on a touchscreen kiosk to use in a 3 arm RCT to evaluate the optimal approach to pain screening, along with an evaluation of the implementation experience. Methodology: Clinicians, clinic staff, and facility staff will be interviewed and multidisciplinary focus groups conducted at 3 sites to characterize the range of themes related to staff perspectives on patient reported versus clinician documented pain. Development of the enhanced pain screening protocol will account for clinician perspectives informed by qualitative input, as well as usability testing, and then subjected to an RCT after being integrated into a kiosk that will be placed in primary care for every Veteran to complete before nursing staff administered pain screening. Veterans will be randomly allocated in a 1:1:1 ratio to the three arms and analyses will evaluate a variety of quantitative and qualitative outcomes. Experience during the trial will inform implementation and be gathered through interviews with both patients and providers and clinic staff. Results: This is a new project and results have not yet been obtained. Significance: We will characterize how to best conduct pain screening including a direct comparison of patient reported (e.g., PRO) to clinician documented pain, and selection of an optimal measure to improve clinician and patient centeredness of pain measurement (e.g., by considering the incorporation of function). This project will inform national VA implementation of a preferred measure and method.

描述（由申请人提供）： 目标：我们混合方法研究的总体目标是评估一种策略，以提高VA初级保健中“第五生命体征”的质量和临床实用性。我们将形式上 评估增强疼痛筛查方法（患者自我管理的计算机支持）的经验和实施，包括临床医生对使用疼痛筛查指导管理的观点。我们的具体目的是：AIM 1。与通常的疼痛筛查，临床实用性以及如何使用技能，角色和多学科临床医生和顾问的技能，角色和任务相比，针对增强疼痛筛查方法的观点来表征AIM 1。访谈将为筛选界面的开发提供信息，我们将在人机交互实验室中评估包括PEG和“ NRS”在内的界面。 AIM 2。在三臂RCT中评估使用PEG（ARM 1）增强疼痛筛查方法的效果，即“ NRS疼痛现在”（ARM 2）（ARM 2），与通常接受临床医生评估的疼痛筛查（ARM 3）相比，（AIM 2A）（AIM 2A）一周和（AIM 2B）的痛苦和（AIM 2B）的可接受性，E.G的痛苦，以及患者的可接受性，痛苦，E。g。满意）使用定量的患者筛查结果，与患者的访谈，诊所和设施员工研究计划：在三个站点（VA GLA，Indianapolis和Portland）的患者访谈，诊所和设施员工研究计划：我们将与初级保健员工进行访谈，以进行痛苦筛查的经验，以培训的方式（peg specters spece novers smection）在痛苦的方法中（va Gla）进行访谈（va gla，印第安纳波利斯和波特兰关于退伍军人人口统计，合并症和评估疼痛的风险的调查问题。集成协议将安装在触摸屏信息亭上，以在3 ARM RCT中使用，以评估疼痛筛查的最佳方法，并评估实施体验。方法论：临床医生，诊所工作人员和设施人员将接受采访，并在3个站点进行的多学科焦点小组，以表征与据报道的患者与临床医生有关的疼痛的患者观点相关的主题范围。增强疼痛筛查方案的开发将解释以定性输入和可用性测试所告知的临床医生观点，然后在整合到售货亭后遭受RCT，并将每位退伍军人置于初级保健中，以便每位退伍军人在护理人员进行疼痛筛查之前完成。退伍军人将以1：1：1的比率随机分配，分析将评估各种定量和定性结果。试验期间的经验将为实施提供信息，并通过对患者，提供者和诊所人员的访谈来收集。结果：这是一个新项目，尚未获得结果。意义：我们将表征如何最好地进行疼痛筛查，包括直接比较报告的患者（例如Pro）与临床医生记录的疼痛，以及选择最佳措施以提高临床医生和患者的疼痛测量中心（例如，通过考虑功能的结合）。该项目将为国家弗吉尼亚州的实施提供首选措施和方法的实施。