Identifying Pain Trajectories In Sickle Cell Disease Using Latent Class Analysis

使用潜在类别分析识别镰状细胞病的疼痛轨迹

• 批准号: 9299186
• 负责人: Angie Mae Rodday
• 金额: $ 26.25万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-23 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9299186
• 关键词: Academic Medical Centers; Accounting; Acute; Admission activity; Adult; Affect; African; African American; Anti-Inflammatory Agents; Anti-inflammatory; Asian Indian; Avascular necrosis of bone; Clinical; Communication; Disease; Emergency department visit; Erythrocytes; Ethnic Origin; European; Future; Goals; Health Care Costs; Health Services Accessibility; Healthcare; Hematological Disease; Hemolytic Anemia; Heritability; Hispanics; Home environment; Hospitalization; Individual; Inpatients; Insurance Coverage; Intervention; Low income; Measures; Methodology; Minority Groups; Morbidity - disease rate; Numeric Rating Scale; Opioid; Outcome; Outpatients; Overdose; Pain; Pain Measurement; Pain intensity; Pain management; Patient Outcomes Assessments; Patient risk; Patients; Pattern; Perception; Pharmaceutical Preparations; Pneumonia; Postoperative Pain; Prevalence; Prospective Studies; Provider; Race; Recruitment Activity; Reporting; Retrospective cohort; Risk; Septicemia; Severity of illness; Sickle Cell; Sickle Cell Anemia; Signal Transduction; Statistical Methods; Techniques; Variant; acute chest syndrome; addiction; body system; cancer pain; clinical care; drug addict; ethnic minority population; exhaust; experience; health care disparity; health care service utilization; health related quality of life; high risk; improved; innovation; mortality; patient home care; prospective; racial and ethnic disparities; racial minority; treatment strategy

PROJECT SUMMARY/ABSTRACT Sickle cell disease (SCD) is a group of heritable red blood cell disorders that primarily affect individuals who identify as Black or African-American. Other affected groups include those of Hispanic, southern European, Middle Eastern, and Asian Indian descent. The hallmark of SCD is the painful vaso-occlusive crisis (VOC), which is still not well understood or managed. This may result in delays in treatment, undertreatment, and unnecessary suffering. Because SCD primarily affects African-Americans and other minority groups, mistrust between patients and providers may put patients with SCD at increased risk of healthcare disparities, including reduced access to necessary pain management. For most patients, pain is managed at home, further contributing to underestimation by healthcare practitioners of the prevalence and impact of SCD pain. However, when patients in VOC present acutely, they have usually exhausted home care and outpatient therapies, thereby signaling the need for parenteral opioids. Using a retrospective cohort of 150 patients with SCD hospitalized at one urban academic medical center, the overall goal of this study is to develop methodology to characterize the sickle cell pain trajectory. Specifically, the aims are to (1) use latent class analysis to identify different patterns of pain trajectories during hospitalizations for sickle cell pain crisis and determine socio-demographic and clinical factors associated with the different pain trajectories; (2) describe the relationship between treatment management strategies and sickle cell pain scores during hospitalization; and (3) assess the relationship between different patterns of sickle cell pain trajectories and future readmission for sickle cell pain crisis. Results from the proposed study can then be used to develop prospective studies to better measure pain during hospitalizations or to identify factors that affect the pain trajectory, which can be used to target interventions or pain management approaches. In addition, better characterization of the pain trajectory and treatment of pain in SCD are especially urgent as efforts are made nationally to restrict access to opioids given the current crisis of abuse, addiction, and overdose. Patients experiencing severe and devastating pain, such as those with SCD, should not be made to suffer because they are denied necessary treatment.

项目总结/摘要 镰状细胞病（SCD）是一组遗传性红细胞疾病，主要影响以下个体： 被认为是黑人或非裔美国人。其他受影响的群体包括西班牙裔，南欧人， 中东和亚洲印第安血统。SCD的标志是疼痛的血管闭塞危象（VOC）， 这仍然没有得到很好的理解和管理。这可能导致治疗延迟、治疗不足， 不必要的痛苦。由于SCD主要影响非洲裔美国人和其他少数民族， 患者和医疗服务提供者之间的差异可能会增加SCD患者的医疗差异风险，包括 减少了必要的疼痛管理。对于大多数患者来说，疼痛是在家里管理的， 导致医疗从业者低估SCD疼痛的患病率和影响。 然而，当VOC患者急性发作时，他们通常已经耗尽了家庭护理和门诊治疗， 治疗，从而表明需要胃肠外阿片类药物。使用150例患者的回顾性队列， SCD住院的一个城市学术医疗中心，这项研究的总体目标是发展 描述镰状细胞疼痛轨迹的方法。具体而言，其目的是（1）使用潜在类 分析以确定镰状细胞疼痛危象住院期间疼痛轨迹的不同模式， 确定与不同疼痛轨迹相关的社会人口统计学和临床因素;（2）描述 住院期间治疗管理策略与镰状细胞疼痛评分之间的关系; 以及（3）评估镰状细胞疼痛轨迹的不同模式与未来再入院之间的关系 治疗镰状细胞病拟议研究的结果可用于开展前瞻性研究， 更好地测量住院期间的疼痛或识别影响疼痛轨迹的因素， 用于针对性干预或疼痛管理方法。此外，更好地描述疼痛 SCD患者疼痛的轨迹和治疗尤为紧迫，因为在全国范围内努力限制获得 阿片类药物鉴于目前的滥用，成瘾和过量的危机。发生重度和 毁灭性的痛苦，如那些与SCD，不应该遭受，因为他们被剥夺了必要的 治疗