Pain Management for Older Adults Living in Nursing Homes

居住在疗养院的老年人的疼痛管理

基本信息

批准号：
9272609
负责人：
Kate L Lapane
金额：
$ 29.7万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-02 至 2018-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9272609
关键词：
Acute Address Adverse effects Adverse event Age Aging Americas Analgesics Anxiety Area Benefits and Risks Certification Characteristics Clinical Clinical Trials Consensus Development Constipation Data Data Set Databases Diagnosis Disease Drug Kinetics Elderly Elements Eligibility Determination Ensure Ethnic Origin Evaluation Event Fatigue Fracture Future Gastrointestinal Hemorrhage Gender Health Hospitalization Impaired cognition Incidence Institute of Medicine (U.S.)Intervention Intervention Studies Knowledge Lead Life Malignant Neoplasms Measures Medical Medicare Medicare claim Medicare/Medicaid Mental Depression Modeling Non-Malignant Nursing Homes Online Systems Outcome Pain Pain Measurement Pain management Patients Pattern Pharmaceutical Preparations Pharmacodynamics Phase Polypharmacy Practice Management Prevalence Provider Public Health Publishing Quality Indicator Quality of life Race Regimen Reporting Sample Size Science Sensory Sleep disturbances Source Statistical Methods Structural Models Subgroup Surveys Symptoms System Techniques Technology Time Treatment outcome Work age related base cancer diagnosis cancer pain clinical practice comparative effectiveness crosslink disability evidence based guidelines experience falls functional disability improved individual patient individualized medicine innovation insight mathematical model non-cancer pain novel pain symptom personalized medicine programs safety study symptom cluster symptom management symptomatology

项目摘要

DESCRIPTION (provided by applicant): PA-13-058 (Pain in Aging): The 2011 Institute of Medicine report entitled "Relieving Pain in America" noted that 62% of nursing home (NH) residents experience pain. Despite a decade of evidence, the introduction of quality indicators and the initiation of quality improvement programs, pain management in nursing homes is sub-optimal. Pain is seldom an isolated symptom and is often associated with/accompanied by other symptoms in common clusters. The proposed work seeks to use a novel analytic approach to characterize pain symptom clusters in NH residents using a contemporaneous dataset. We propose merging elements of the following existing databases: the Minimum Data Set (MDS), Medicare eligibility and claims data (Part A, B & D), and the Certification and Survey Provider Enhanced Reporting (CASPER) system. The specific aims are to: 1) Identify the most common and burdensome pain symptom clusters among nursing home residents and describe correlates of pain symptom clusters; 2) Describe medication use by pain symptom clusters; 3) Evaluate trajectories of pain symptom clusters and corresponding medication use; and 4) Quantify the extent to which medications are associated with outcomes such as improvements in pain trajectories and adverse events (falls, fractures, constipation, and overall hospitalizations and hospitalizations for specific causes). State of the art statistical techniques including latent clas modeling and marginal structural models will be used. All analyses will be conducted by underlying diagnosis (e.g., those with and without a cancer diagnosis), sociodemographic (age, gender and race/ethnicity), and cognitive and functional impairment. Despite administrative initiatives including the inclusion of pain as a quality indicator and public reporting of measures and directives in surveyors' interpretive guidance documents regarding polypharmacy and pain, untreated, potentially undertreated and inappropriately treated pain remain common in the nursing home setting. No studies have attempted to characterize pain symptom clusters in nursing homes and to longitudinally explore the changes in pain, pharmacological pain treatments, and outcomes in a contemporaneous national dataset of nursing home residents. This is a novel area of exploration that will provide needed information to form the basis of strategies to improve pain management in NHs.

描述（由适用提供）：PA-13-058（衰老疼痛）：2011年医学研究所报告的标题为“缓解美国疼痛”指出，有62％的护士住所（NH）居民经历疼痛。尽管有十年的证据，引入质量指标和质量改进计划的主动性，疗养院的疼痛管理是最佳的。疼痛很少是一种孤立的症状，通常与/伴有常见簇中的其他症状有关。拟议的工作试图使用一种新颖的分析方法来表征使用现代数据集中NH居民中疼痛症状簇的表征。我们建议合并以下现有数据库的元素：最小数据集（MDS），Medicare资格和索赔数据（A部分，B＆D）以及认证和调查提供商增强报告（CASPER）系统。具体目的是：1）确定护士居民中最常见和抛光的疼痛症状簇，并描述疼痛症状簇的相关性； 2）描述用疼痛症状簇使用用药； 3）评估疼痛症状簇的轨迹和相应的药物使用； 4）量化药物与预后相关的程度，例如疼痛轨迹和不良事件的改善（跌落，裂缝，便秘以及整体住院以及特定原因的住院）。将使用最先进的统计技术，包括潜在CLAS建模和边际结构模型。所有分析将通过潜在的诊断（例如有和没有癌症诊断的患者），社会人口统计学（年龄，性别和种族/种族/种族）以及认知和功能障碍来进行。尽管行政计划包括将疼痛作为质量指标和公开报告包括在内以及测量师关于多药和疼痛的解释性指导文件，未经治疗，潜在的不足和不适当治疗的疼痛在疗养院环境中仍然很常见。没有研究试图表征疗养院中的疼痛共簇，并纵向探索疼痛，药物疼痛治疗的变化以及当代国家疗养院居民数据集中的结果。这是一个新颖的探索领域，它将提供所需的信息，以构成改善NHS疼痛管理的策略的基础。