Pain Management for Older Adults Living in Nursing Homes

 描述（由申请人提供）：PA-13-058（衰老中的疼痛）：2011年医学研究所题为“缓解美国疼痛”的报告指出，62%的疗养院（NH）居民经历疼痛。尽管有十年的证据，质量指标的引入和质量改进计划的启动，疼痛管理在养老院是次优的。疼痛很少是一个孤立的症状，往往与/伴随着其他症状的共同集群。拟议的工作旨在使用一种新的分析方法来表征疼痛症状集群在NH居民使用同期的数据集。我们建议合并以下现有数据库的元素：最小数据集（MDS），医疗保险资格和索赔数据（A，B和D部分），以及认证和调查提供商增强报告（CASPER）系统。具体目标是：1）识别护理之家居民中最常见和负担最重的疼痛症状群，并描述疼痛症状群的相关性; 2）描述疼痛症状群的药物使用; 3）评估疼痛症状群的轨迹和相应的药物使用;和4）量化药物与结果（例如疼痛轨迹和不良事件的改善）相关的程度（福尔斯、骨折、便秘、总体住院和特定原因住院）。最先进的统计技术，包括潜在类建模和边际结构模型将被使用。所有分析将根据基础诊断进行（例如，有和没有癌症诊断的人）、社会人口统计学（年龄、性别和种族/民族）以及认知和功能障碍。尽管行政举措包括将疼痛作为质量指标和公开报告措施 调查员解释性指导文件中关于多种药物和疼痛、未治疗、可能治疗不足和治疗不当的疼痛的指示在疗养院环境中仍然很常见。没有研究试图表征疼痛症状集群在养老院和纵向探讨疼痛的变化，药物疼痛治疗，并在同一时期的全国数据集的养老院居民的结果。这是一个新的探索领域，将提供所需的信息，形成战略的基础，以改善疼痛管理的国家卫生机构。

 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.