Pain Management for Older Adults Living in Nursing Homes

 描述(由申请人提供)：PA-13-058(老年疼痛)：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)居民经历过疼痛。尽管有十年的证据，引入了质量指标，并启动了质量改进计划，但疗养院的疼痛管理并不理想。疼痛很少是一种孤立的症状，经常伴随/伴随着常见的群集性其他症状。这项拟议的工作试图使用一种新的分析方法来描述NH居民的疼痛症状群，使用同期的数据集。我们建议合并以下现有数据库的元素：最低数据集(MDS)、联邦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者增强型报告(CASPER)系统。具体目标是：1)确定疗养院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)描述疼痛症状群的用药情况；3)评估疼痛症状群的轨迹和相应的用药情况；以及4)量化药物与疼痛轨迹和不良事件(跌倒、骨折、便秘，以及因特定原因住院和住院的总人数)等结果的关联程度。将使用最新统计技术，包括潜在类建模和边缘结构模型。所有分析将根据基本诊断(例如，有和没有癌症诊断的人)、社会人口学(年龄、性别和种族/民族)以及认知和功能障碍进行。尽管采取了行政举措，包括将疼痛列为质量指标和公开报告措施 调查员的解释性指导文件中关于多药和疼痛、未经治疗、可能治疗不足和治疗不当的疼痛的指令在疗养院环境中仍然很常见。还没有研究试图描述疗养院疼痛症状群的特征，并纵向探索疗养院居民同期全国数据集中疼痛、药理疼痛治疗和结果的变化。这是一个新的探索领域，将提供必要的信息，以形成战略的基础，以改善NHS的疼痛管理。

 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.