Pain Assessment Interview and Clinical Advisory System

描述（由申请人提供）：该II期申请继续开发疼痛评估访谈网络-临床咨询系统（painCAS），这是一种对慢性疼痛患者进行系统和测试的计算机管理评估。初始评估和随访模块评估患者在进入或继续治疗慢性疼痛时的相关健康和功能信息。提供者初始和随访报告以方便的方式组织患者信息，使提供者注意到值得注意的健康和功能问题。评估包括误用和滥用处方止痛药的风险评估。painCAS还生成专门针对患者的报告。最后，painCAS包括以提供者为中心的工具，用于上传和分析接受painCAS评估的患者的汇总数据，以及可以帮助指导治疗的决策支持资源。这种疼痛管理资源将使医生能够最大限度地利用门诊就诊时间，同时最大限度地减少治疗的潜在不利影响，例如滥用或误用止痛药。多种因素的综合作用表明，采用painCAS等临床工具的时机已经成熟：(1)医疗保健政策制定者和付款人对系统化护理、记录、风险评估和处方的压力越来越大；(2)公众对适当疼痛治疗的需求；(3)公众、行业和监管机构对处方药误用和滥用的担忧；(4)提高临床环境对计算机评估和工具（包括电子病历）的接受度；(5)对临床途径和疾病管理的兴趣日益增加，以提高护理的效率和质量；(6)越来越认识到从多维角度理解某些慢性疾病的重要性。美国疼痛医学学会（American Academy of pain Medicine， AAPM）指出，尽管开发电子疼痛评估的必要性和先前的一些努力，但尚未有任何系统被广泛采用。基于我们以前开发和传播电子评估的工作，以及为系统增加价值的创新功能组合，我们有充分的理由采用painCAS。在第一阶段，为系统设计奠定了基础，该系统将适应临床活动流程，满足重要的评估和报告需求，并直接向患者提供相关信息。第二阶段将完成评估和设计的其余部分，并建造已完成的painCAS系统，以便在实地试验中进行测试。在第二阶段，一项针对疼痛专科诊所患者的多水平、对照、随机临床试验将测试painCAS对疼痛评估条件和常规治疗条件下治疗过程和结果的影响。经过测试的假设是，painCAS将：1)标准化慢性疼痛评估的文件，2)增加在医疗访问中讨论适当主题和问题的可能性，以及3)提高患者对治疗的满意度。二级分析将检查使用painCAS与疼痛功能、情绪和药物误用/滥用的改善相关的程度。提出的painCAS潜在地解决了现有努力的局限性，以加强慢性疼痛治疗的评估和实践。

DESCRIPTION (provided by applicant): This Phase II application continues development of the Pain Assessment Interview Network - Clinical Advisory System (painCAS), a systematic and tested computer-administered assessment of chronic pain patients. Initial Assessment and Follow-up modules assess relevant health and functioning information of patients as they enter or continue treatment for chronic pain. Provider Initial and Follow-up Reports organize patient information in a convenient way that brings to the provider's attention notable health and functioning issues. The assessment includes an evaluation of risk for misuse and abuse of prescription pain medication. painCAS also generates a report specifically intended for patients. Finally, painCAS includes provider-focused tools for uploading and analyzing aggregate data for patients who have taken the painCAS assessments, as well as a Decision Support resource that can help guide treatment. Such a pain management resource would allow a physician to maximize the available time in a clinic encounter while minimizing potential adverse impacts of treatment, such as abuse or misuse of analgesics. A convergence of factors suggests the time is right for a clinical tool like the painCAS: (1) increasing pressure from healthcare policy makers and payors to systematize care, documentation, risk assessment, and prescribing; (2) public demands for adequate pain treatments; (3) public, industry, and regulator concerns about prescription medication misuse and abuse; (4) increasing acceptance of computer assessment and tools (including EMRs) in clinical settings; (5) increasing interest in clinical pathways and disease management to improve the efficiency and quality of care, and (6) an increasing recognition of the importance of understanding certain chronic conditions from a multidimensional perspective. Despite the need and several prior efforts to develop electronic pain assessments, the American Academy of Pain Medicine (AAPM) notes that no system has yet been widely adopted. Building on our prior work developing and disseminating electronic assessments as well as an innovative combination of features that add value to the system, a strong case can be made that the painCAS will be adopted. During Phase I, the groundwork was laid for a system design that will fit into the flow of clinical activities, meet important assessment and reporting needs, and provide relevant information directly to patients. Phase II will see the completion of remaining components of the assessments and design and the building of the completed painCAS system to be tested in a field trial. In Phase II, a multilevel, controlled, randomized clinical trial of patients in pain specialty clinics will test the impact of painCAS on treatment process and outcome against a painCAS assessment only condition and a treatment-as-usual condition. The tested hypotheses are that the painCAS will: 1) standardize documentation of chronic pain assessments, 2) increase the likelihood of discussion of appropriate topics and issues during the medical visit, and 3) improve the patient's satisfaction with treatment. Secondary analyses will examine the extent to which painCAS use is associated with improvement in pain functioning, mood, and misuse/abuse of medications. The proposed painCAS potentially addresses limitations of existing efforts to enhance assessment and practice in the treatment of chronic pain. PUBLIC HEALTH RELEVANCE: As society increasingly demands that medical professionals address the complex clinical presentations of patients with chronic pain, it is increasingly important that providers have the benefit of standardized computer- administered assessments along with computerized treatment recommendations. Successful development and dissemination of a comprehensive, integrated Pain Assessment Interview Network - Clinical Advisory System (painCAS) will go some distance toward enhancing assessment and treatment of chronic pain and be perceived as highly valuable to stakeholders. We believe this product has enormous commercial viability and public health importance and that its innovative combination of features will overcome obstacles to adoption that have plagued other electronic pain assessment systems.