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)： 目的：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”的质量和临床有效性。我们将在形式上 评估增强型疼痛筛查方法的经验和实施(患者自我管理的计算机辅助)，包括临床医生对使用疼痛筛查来指导治疗的看法。我们的具体目标是：目标1.描述初级保健团队对增强疼痛筛查方法与常规疼痛筛查方法的比较、临床有效性以及如何使用多学科临床医生和顾问的技能、角色和任务来优化疼痛护理。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该界面，包括聚乙二醇仪和‘NRS NOW’。目的2.在一项三臂随机对照试验中，与通常的临床医生评估的疼痛筛查(ARM 3)相比，在(目标2a)一周后检测患者疼痛和(目标2b)可行性、可接受性和使用定量患者筛查结果的患者报告的计算机辅助疼痛评估(例如，旁观者完成率、患者和工作人员体验和满意度)方面，与通常的临床医生评估的疼痛筛查(ARM 3)相比，评估使用PEG(ARM 1)、‘NRS Pain Now’(ARM 2)的增强疼痛筛查方法的效果，以及与患者、临床和设施工作人员的访谈研究计划：在三个站点(VA GLA，印第安纳波利斯，我们将采访初级保健人员，了解他们在疼痛筛查方面的经验，以及如何将筛查与管理联系起来，以便在触摸屏上开发集成的增强型疼痛筛查方法(现在使用PEG和NRS)，以及关于退伍军人人口统计、合并发病率和被低估疼痛风险的调查问题。集成的协议将安装在触摸屏终端上，用于3臂随机对照试验，以评估疼痛筛查的最佳方法，以及实施体验的评估。方法：临床医生、诊所工作人员和设施工作人员将接受采访，并在3个地点进行多学科焦点小组，以确定与工作人员对患者报告的疼痛和临床医生记录的疼痛的看法相关的主题范围。增强型疼痛筛查方案的开发将考虑到临床医生的观点，包括定性输入和可用性测试，然后在整合到信息亭后接受RCT，该信息亭将被放置在初级保健中，供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的比例随机分配到三个部门，分析将评估各种定量和定性的结果。试验期间的经验将为实施提供信息，并通过与患者、提供者和诊所工作人员的面谈来收集。结果：这是一个新的项目，尚未取得成果。意义：我们将描述如何最好地进行疼痛筛查，包括将患者报告的疼痛(例如PRO)与临床医生记录的疼痛进行直接比较，以及选择最佳措施来改善临床医生和患者以疼痛测量为中心的情况(例如，通过考虑纳入功能)。该项目将向国家退伍军人管理局通报首选措施和方法的实施情况。