Pain in children: clinical, patient experience, and resource utilization outcome disparities surrounding invasive emergency department procedures

儿童疼痛：侵入性急诊科手术的临床、患者体验和资源利用结果差异

• 批准号: 10674872
• 负责人: Sarah R Martin
• 金额: $ 16.76万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10674872
• 关键词: 9 year old; Accident and Emergency department; Address; Adult; Affect; Analgesics; Anxiety; Awareness; Behavioral; California; Caring; Child; Child Support; Child health care; Childhood; Client satisfaction; Clinical; Clinical Research; Clinical Sciences; County; Critical Illness; Development; Dimensions; Disparity; Distress; Emergency department visit; Environment; Equity; Evaluation; Future; General Population; Guidelines; Health; Health Disparities Research; Healthcare Systems; Injury; Interdisciplinary Study; Intervention; Latinx; Latinx population; Leadership; Length of Stay; Literature; Longitudinal cohort study; Medical; Mentors; Mentorship; Methods; National Institute of Child Health and Human Development; National Institute on Minority Health and Health Disparities; Needles; Operative Surgical Procedures; Oranges; Outcome; Pain; Pain management; Patient-Centered Care; Patients; Pattern; Pediatric Hospitals; Pharmaceutical Preparations; Policies; Population; Populations at Risk; Procedures; Productivity; Provider; Recovery; Research; Research Ethics; Research Priority; Resources; Risk; Sampling; Social Values; Statistical Models; Stress; Training; Translational Research; United States National Institutes of Health; Universities; Vulnerable Populations; Wait Time; Work; adverse outcome; bone fracture repair; care costs; career development; effective therapy; ethnic disparity; ethnic diversity; experience; health care disparity; high risk; improved; improved outcome; innovation; interdisciplinary approach; long term recovery; medical schools; minority health; minority health disparity; multidisciplinary; neighborhood disadvantage; outcome disparities; pain outcome; pediatric emergency; pediatric trauma; population health; prevent; procedural pain; professor; programs; psychologic; psychological outcomes; satisfaction; social culture; sociocultural determinant; trait; treatment disparity

PROJECT SUMMARY / ABSTRACT Each year, millions of children sustain injuries and undergo invasive medical procedures in the emergency department (ED). Current guidelines emphasize the need to address the significant pain and distress children experience in the ED, but inadequate pain and distress management remain prevalent. Under-treated pain and distress can result in negative future pain experiences and maladaptive psycho-behavioral outcomes. Recent work suggests that Latinx children are at a particularly high risk for experiencing distress and pain surrounding surgery as well as pain treatment disparities in the ED. This application proposes a large-scale observational, longitudinal cohort study to identify both predictors and outcomes of procedural distress and pain in an ethnically diverse sample of children 2-9 years old undergoing invasive ED procedures. Methods will be based on the NIMHD Minority Health Disparities Research Framework and Triple Aim and will include empirically informed assessments of psychological, sociocultural, environmental, healthcare system, clinical recovery, patient experience, and resource utilization variables. The K23 candidate is an Assistant Professor at the University of California-Irvine School of Medicine and aims to establish an independent interdisciplinary research program that improves pediatric pain care and prevents adverse outcomes and healthcare disparities surrounding injury and painful procedures in the pediatric ED. The candidate’s training plan capitalizes on the expertise of a highly experienced multidisciplinary mentorship team, integrating key training in pain surrounding invasive ED procedures, Triple Aim value-based care framework, sociocultural factors in pediatric pain and pediatric healthcare disparities, advanced statistical modeling, and professional development. This application will be executed within the UCI Center on Stress & Health, a highly productive, well-established research environment that incorporates a unique multidisciplinary approach to training and clinical research. The training plan will incorporate didactic coursework, one-on-one mentoring, and UC Irvine Institute for Clinical and Translational Science (NIH CTSA) resources and seminars focused on career development, training evaluation and research ethics. With enthusiastic and material support from the Children’s Hospital of Orange County senior leadership, the project will be conducted in a high-volume pediatric ED where a large proportion of patients (66%) are Latinx and are part of an innovative population health program. Collectively, this will provide an exceptional training environment to characterize multidimensional contributors to procedural pain and distress in a population at-risk for experiencing care disparities and launch a clinically impactful, independent research program that promotes effective and equitable pediatric pain and injury-related care in the ED.

项目总结/摘要 每年有数百万儿童在紧急情况下受伤并接受侵入性医疗程序 部门（艾德）。目前的指导方针强调需要解决的重大疼痛和困扰的儿童 艾德的经验，但不充分的疼痛和痛苦的管理仍然普遍存在。疼痛治疗不足， 痛苦可能导致负面的未来疼痛体验和适应不良的心理行为结果。最近 研究表明，拉丁裔儿童在经历周围的痛苦和痛苦的风险特别高， 手术以及ED中疼痛治疗的差异。本申请提出了一种大规模的观察， 一项纵向队列研究，以确定一个种族中手术痛苦和疼痛的预测因子和结局。 接受侵入性艾德手术的2-9岁儿童的不同样本。方法将基于 NIMHD少数民族健康差异研究框架和三重目标，并将包括经验丰富的 心理、社会文化、环境、医疗保健系统、临床恢复、患者评估 经验和资源利用变量。K23候选人是一个助理教授在大学 加州-欧文医学院，旨在建立一个独立的跨学科研究计划 改善儿科疼痛护理，防止不良后果和围绕损伤的医疗差异 和痛苦的程序在儿科ED。候选人的培训计划利用的专业知识， 经验丰富的多学科指导团队，整合了侵入性艾德周围疼痛的关键培训 程序，三重目标价值为基础的护理框架，儿科疼痛和儿科的社会文化因素 医疗差距，先进的统计建模和专业发展。此应用程序将 在UCI压力与健康中心内执行，这是一个高效，完善的研究环境 它采用独特的多学科方法进行培训和临床研究。培训计划将 结合教学课程，一对一的指导，和加州大学欧文分校临床和翻译研究所 科学（NIH CTSA）资源和研讨会侧重于职业发展，培训评估和研究 伦理在橙子县儿童医院高层领导的热情和物质支持下， 该项目将在高容量儿科艾德进行，其中大部分患者（66%）为拉丁裔 是一项创新的人口健康计划的一部分。总的来说，这将提供一个特殊的培训 描述风险人群中手术疼痛和痛苦的多维因素的环境 并启动一项具有临床影响力的独立研究计划， 急诊室有效且公平的儿科疼痛和损伤相关护理。

项目成果

Eliminating pain disparities for children in the emergency department.

• DOI: 10.1111/acem.14723
• 发表时间: 2023-10
• 期刊: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Impact of COVID-19 pandemic on pediatric healthcare burnout in acute care: a longitudinal study.

• DOI: 10.1038/s41390-023-02674-3
• 发表时间: 2023-11
• 期刊: PEDIATRIC RESEARCH
• 影响因子: 3.6
• 作者: Martin, Sarah R.;Heyming, Theodore;Morphew, Tricia;Sayrs, Lois;Fortier, Michelle A.;Sanger, Terence;Kain, Zeev N.
• 通讯作者: Kain, Zeev N.