Pain Assessment Interview and Clinical Advisory System

描述（由申请人提供）：本II期申请继续开发疼痛评估访谈网络-临床咨询系统（painCAS），这是一种系统性和经过测试的计算机管理的慢性疼痛患者评估。初始评估和随访模块评估患者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，引起提供者注意显著的健康和功能问题。该评估包括对处方止痛药误用和滥用风险的评价。painCAS还生成专门针对患者的报告。最后，painCAS包括以提供商为中心的工具，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。这样的疼痛管理资源将允许医生最大化诊所就诊的可用时间，同时最小化治疗的潜在不利影响，例如滥用或误用止痛剂。一系列因素表明，像painCAS这样的临床工具的时机已经成熟：（1）来自医疗保健政策制定者和支付者的压力越来越大，要求系统化护理，文档，风险评估和处方;（2）公众对充分疼痛治疗的需求;（3）公众，行业和监管机构对处方药误用和滥用的担忧;（4）医疗保健政策制定者和支付者对医疗保健，文档，风险评估和处方的压力越来越大;（5）公众，行业和监管机构对处方药误用和滥用的担忧。（4）提高对计算机评估和工具的接受度（包括电子病历）;（5）增加对临床路径和疾病管理的兴趣，以提高护理的效率和质量，以及（6）越来越多的人认识到从多方面理解某些慢性病的重要性。尽管有必要和几个先前的努力，以开发电子疼痛评估，美国疼痛医学学会（AAPM）指出，还没有系统被广泛采用。基于我们先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，可以提出一个强有力的理由，即painCAS将被采用。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的流程，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，并建造完成的painCAS系统，进行实地试验。在第二阶段，疼痛专科诊所患者的多水平，对照，随机临床试验将测试painCAS对治疗过程和结果的影响，对照painCAS评估条件和常规治疗条件。检验的假设是painCAS将：1）标准化慢性疼痛评估的文件，2）增加医疗访视期间讨论适当主题和问题的可能性，3）提高患者对治疗的满意度。次要分析将检查painCAS使用与疼痛功能、情绪和药物误用/滥用改善的相关程度。拟议的painCAS潜在地解决了现有努力的局限性，以加强评估和实践中的慢性疼痛治疗。 公共卫生相关性：随着社会越来越多地要求医疗专业人员解决慢性疼痛患者的复杂临床表现，越来越重要的是，提供者受益于标准化的计算机管理的评估沿着计算机化的治疗建议。成功开发和传播一个全面、综合的疼痛评估访谈网络-临床咨询系统（painCAS）将有助于加强慢性疼痛的评估和治疗，并被利益相关者视为非常有价值。我们相信这款产品具有巨大的商业可行性和公共健康的重要性，其创新的功能组合将克服困扰其他电子疼痛评估系统的障碍。

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.