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

• 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
• 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

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）在不同患者人群（包括癌症、镰状细胞病和骨科手术）中改善疼痛和症状管理的疗效。MT是定制音乐干预的临床应用（例如，主动的音乐制作和音乐辅助的放松）以在有资格的专业人员（即，认证的音乐治疗师）。尽管有来自随机对照试验的证据表明MT的疗效，以及MT在临床环境中的增加，但很少有临床有效性研究评估MT在卫生系统中的现实影响。评估MT等综合疼痛管理方法是一项至关重要的需求，特别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阿片类药物使用带来的风险时。在理解MT的临床有效性方面仍存在重大差距。其中包括：1）识别与患者报告的结果测量（PROM）的变化相关的社会人口统计学、临床和MT干预特征; 2）比较结果（例如，药物使用和住院时间）之间的患者接受MT和类似的患者接受常规护理;和3）检查纵向影响PROM超出了最初的MT会议。使用大型电子健康记录（EHR）数据集的31,359 MT会话提供给15,460例患者（平均年龄63.6岁，33.5%黑人/非洲裔美国人）在20,405住院，我建议应用回归模型，倾向评分匹配，纵向混合效应模型来检查MT的临床有效性。我的具体目标是：目标1）调查哪些人口统计学特征（例如，年龄和性别），健康的社会决定因素（例如，保险状况和收入），临床特征（例如，诊断和护理设置），和/或MT会话特征（例如，长度和所使用的MT干预）与PROM的变化相关联（即，0-10压力、疼痛强度、焦虑和应对措施）; AIM 2）比较接受MT的住院患者和倾向评分匹配的对照组之间的结局，包括住院时间、针对疼痛和焦虑给予的药物以及纵向疼痛强度评分;以及探索性AIM 3）检查接受MT的患者在住院期间对PROM的纵向影响。该提案将为申请人提供进行未来基于实践的临床有效性研究所需的基础知识和经验，不仅在MT中，而且在多种综合疗法中（例如，针灸和按摩疗法）。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模式，本提案中获得的技能对于理解综合健康和医学模式的现实影响以及改善循证患者护理尤为重要。