Enhancing Geriatric Pain Care with Contextual Patient Generated Profiles

通过根据患者情况生成的档案来加强老年疼痛护理

• 批准号: 9952556
• 负责人: Jorie Michaela Butler
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-11-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9952556
• 关键词: Address; Adherence; Adult; Age; Aging; Area; Behavior; Caregivers; Caring; Client satisfaction; Clinic; Clinical; Cognitive; Collection; Communities; Complex; Coupled; Data; Data Collection; Data Display; Data Element; Diagnosis; Disease; Elderly; Electronic Health Record; Elements; Environment; Evaluation; Family; Family member; Feedback; Focus Groups; Future; Geriatrics; Goals; Health; Healthcare; Home; Home environment; Household; Informatics; Intervention; Life; Link; Medical; Methodological Studies; Methods; Modeling; Modification; Monitor; Nurse Practitioners; Nurses; Opioid; Outcome; Pain; Pain management; Patient Care; Patient Outcomes Assessments; Patient Self-Report; Patient-Centered Care; Patients; Perception; Persons; Pharmaceutical Preparations; Physical activity; Physicians; Polypharmacy; Primary Health Care; Principal Investigator; Process; Provider; Psychologist; Quality of life; Randomized; Regimen; Reporting; Research; Risk; Role; Sampling; Self Efficacy; Social Network; Social Workers; Techniques; Testing; Training; United States Department of Veterans Affairs; Veterans; Visit; Voting; Work; addiction; base; care delivery; chronic pain; chronic pain patient; clinical pain; compliance behavior; connected care; daily functioning; design; experience; follow-up; functional decline; human old age (65+); improved; information display; innovation; insight; member; military veteran; opioid overdose; overdose death; pain patient; patient oriented; personalized care; point of care; prescription opioid; primary outcome; prototype; randomized trial; rural setting; satisfaction; secondary outcome; shared decision making; simulation; study population; tool; urban setting; usability

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.

背景：疼痛不是衰老不可避免或正常的一部分。然而，老年患者的慢性疼痛是 广泛，发生在大约50%的65岁或以上的社区居住成年人中。治疗无效 慢性疼痛患者有生活质量较差和功能下降的风险。阿片类药物成瘾的风险 越来越多的老年疼痛患者认识到，有证据表明， 老年病患者很常见，评估具有挑战性，需要全人诊断方法， 治疗和监测。本研究的目的是完善和测试一种方法，以创建上下文患者 生成的数据（PGD）配置文件，以指导老年疼痛护理。 意义/影响：我们提出的工作将有助于有效的疼痛管理和患者的交付 中心护理拟议的工作与退伍军人事务部的许多高优先级领域，包括老龄化的退伍军人， 疼痛管理，信息学和整体健康，并对重新设计电子 健康记录（EHR）。 创新：这项研究包括一个创新的方法，以病人为中心的护理，通过检查上下文PGD 对患有慢性疼痛的弱势退伍军人群体做出了深入贡献。 具体目标： 目标1：优先考虑上下文PGD配置文件的内容，以支持以患者为中心的老年退伍军人护理 慢性疼痛。 目标2：开发一个原型上下文PGD显示和评估其可用性。 目的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。 方法学：研究人群是患有慢性疼痛的退伍军人，参与其日常生活的照顾者， 在城市和城市的初级保健或老年病诊所治疗这些退伍军人的初级保健临床医生， 农村环境。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，将焦点小组与 临床医生和退伍军人患者和护理人员，并系统评价 上下文PGD开发和优化退伍军人贡献上下文PGD的方法。此外，VHA 初级保健和老年病诊所的临床医生将参加一个名义上的小组技术，他们将 审查背景PGD要素，并就这些要素对其作为临床医生角色的重要性进行投票 并且通常用于患者的疼痛管理护理。另一组PACT成员将参与 卡片分类更详细地报告特定上下文PGD元素的相关性。会有 在患者水平上进行随机比较，比较包括背景PGD和 没有。主要结果包括图表中记录的临床决策的适当性， 由临床专家评定，并评估随访时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。 后续步骤/实施：我们的项目包括多项评估，旨在改善 与我们的业务合作伙伴密切合作， 医疗保健信息学、互联护理和以患者为中心的护理以及文化转型。