Developing Real-world Understanding of Medical Music therapy using the Electronic Health Record (DRUMMER)

使用电子健康记录 (DRUMMER) 培养对医学音乐治疗的真实理解

基本信息

批准号：
10748859
负责人：
Samuel Rodgers-Melnick
金额：
$ 4.77万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2024
资助国家：
美国
起止时间：
2024-01-01 至 2025-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10748859
关键词：
Acupuncture Therapy Acute Pain Address Admission activity Adult African American Age Analgesics Anxiety Black race Board Certification Breast Cancer Center Cardiovascular system Caring Characteristics Clinical Clinical effectiveness Communities Community Hospitals Credentialing Data Set Development Diagnosis Dose Effectiveness Electronic Health Record Fatigue Future Goals Health system Hospitalization Hospitals Income Inpatients Insurance Coverage Integrative Medicine Integrative Therapy Intervention Joints Knowledge Length Length of Stay Malignant Neoplasms Manuscripts Massage Measures Medical Medical center Mental Depression Mental Health Methods Modality Modeling Music Music Therapy Neighborhoods Nurses Oncology Orthopedic Surgery Orthopedics Outcome Outcome Measure Pain Pain intensity Pain management Palliative Care Patient Care Patient Outcomes Assessments Patients Pattern Pharmaceutical Preparations Population Race Randomized, Controlled Trials Relaxation Risk Reduction Sickle Cell Anemia Spine surgery Stress Therapeutic Therapeutic Intervention Treatment Efficacy Work clinically significant coping demographics effectiveness research effectiveness study evidence base experience improved medication administration opioid use patient population process improvement prospective response sex skill acquisition social health determinants sociodemographics stem symptom management symptom treatment symptomatic improvement systematic review tool treatment as usual

项目摘要

PROJECT SUMMARY/ABSTRACT Several randomized controlled trials (RCTs) support the efficacy of music therapy (MT) for improving pain and symptom management in diverse patient populations including cancer, sickle cell disease, and orthopedic surgery. MT is the clinical use of tailored music interventions (e.g., active music making and music-assisted relaxation) to accomplish individualized goals within a therapeutic relationship by a credentialed professional (i.e., board-certified music therapist). Despite evidence for MT’s efficacy from RCTs and the increased delivery of MT in clinical settings, few clinical effectiveness studies have evaluated the real-world impact of MT within health systems. Evaluating integrative pain management approaches such as MT is a vital need, especially as health systems seek effective nonpharmacologic pain management solutions to reduce risks stemming from opioid use. Substantial gaps remain in understanding MT’s clinical effectiveness. These include: 1) identifying socio-demographic, clinical, and MT intervention characteristics associated with changes in patient-reported outcome measures (PROMs); 2) comparing outcomes (e.g., medication use and length of stay) between patients receiving MT and similar patients receiving usual care; and 3) examining longitudinal effects on PROMs beyond the initial MT session. Using a large electronic health record (EHR) dataset of 31,359 MT sessions provided to 15,460 patients (mean age 63.6 years, 33.5% Black/African American) across 20,405 hospital admissions, I propose applying regression models, propensity-score matching, and longitudinal mixed effects models to examine the clinical effectiveness of MT. My Specific Aims are: AIM 1) investigate which demographic characteristics (e.g., age and sex), social determinants of health (e.g., insurance status and income), clinical characteristics (e.g., diagnoses and care setting), and/or MT session characteristics (e.g., length and MT interventions utilized) are associated with changes in PROMs (i.e., 0-10 measures of stress, pain intensity, anxiety, and coping); AIM 2) compare outcomes including length of stay, medications administered for pain and anxiety, and longitudinal pain intensity scores between inpatients receiving MT and propensity-score matched controls; and EXPLORATORY AIM 3) examine longitudinal effects on PROMs over the course of hospital admissions among patients receiving MT. This proposal will provide the applicant with foundational knowledge and experience needed to conduct future practice-based clinical effectiveness research not only in MT, but across multiple integrative therapies (e.g., acupuncture and massage therapy) deployed within health systems. As health systems develop EHR-based quality improvement tools and implement nonpharmacologic pain modalities, the skills acquired within this proposal will be especially important for understanding the real-world impact of integrative health and medicine modalities and improving evidence-based patient care.

项目摘要/摘要几项随机对照试验（RCT）支持音乐疗法（MT）改善癌症，镰状细胞病和骨科手术在内的潜水患者人群的疼痛和症状管理的效率。 MT是量身定制的音乐干预措施（例如，积极的音乐制作和音乐辅助放松）的临床用途，以实现由资格的专业人士（即董事会认证的音乐治疗师）在治疗关系中实现个性化目标。尽管有证据表明MT在RCT中的有效性以及在临床环境中MT的增加的证据，但很少有临床有效性研究评估了MT在卫生系统中的现实影响。评估诸如MT之类的综合疼痛管理方法是至关重要的需求，尤其是当卫生系统寻求有效的非药物疼痛管理解决方案以减少因使用阿片类药物的风险而减少风险。在理解MT的临床效果方面，存在很大的差距。其中包括：1）确定与患者报告的结果指标变化相关的社会人口统计学，临床和MT干预特征（PROM）； 2）比较接受MT的患者与接受常规护理的类似患者之间的结局（例如，用药和住院时间）； 3）检查最初的MT会议以外的舞会纵向影响。使用20,405次医院入院的大型电子健康记录（EHR）数据集，该数据集提供了31,359吨MT会议（平均年龄63.6岁，黑人/非洲裔美国人33.5％，黑人/非洲裔美国人），我的建议应用回归，有望分数匹配模型和纵向混合效应模型，以检查MT临床疗效。我的具体目的是：目标1）调查哪些人口统计学特征（例如年龄和性别），健康的社会决定者（例如保险状况和收入），临床特征（例如诊断和护理设置）以及/或MT会话特征（例如，长度和MT干预措施）与Proms的频率变化（焦虑症）相关（I.E.，0-10-10-10-10-10-10-10）。目标2）比较包括住院时间，用于疼痛和焦虑的药物的结果，以及接收MT的住院患者与倾向得分匹配的对照之间的纵向疼痛强度评分；和探索目的3）检查接受MT的患者的住院期间对舞会的纵向影响。该提案将为应用程序提供基本知识和经验，不仅在MT中进行基于实践的临床有效性研究，而且在卫生系统中部署的多种综合疗法（例如，针灸和按摩疗法）中进行。随着卫生系统开发基于EHR的质量改进工具并实施非药物疼痛方式，本提案中获得的技能对于理解综合健康和医学方式的现实影响以及改善基于证据的患者护理对现实世界的影响尤为重要。