Pain Assessment Interview and Clinical Advisory System

描述(由申请者提供)：此第二阶段应用程序继续开发疼痛评估面谈网络-临床咨询系统(Pain CAS)，这是一种对慢性疼痛患者进行的系统和经过测试的计算机管理评估。初步评估和后续模块评估患者在接受或继续接受慢性疼痛治疗时的相关健康和功能信息。提供者的初始和后续报告以一种方便的方式组织患者信息，使提供者注意到显著的健康和功能问题。评估包括对滥用和滥用处方止痛药的风险进行评估。Pain CAS还会生成一份专门针对患者的报告。最后，Pain CAS包括以提供商为中心的工具，用于上传和分析接受Pain CAS评估的患者的汇总数据，以及有助于指导治疗的决策支持资源。这样的疼痛管理资源将使医生能够最大限度地利用临床会诊的可用时间，同时将治疗的潜在不利影响降至最低，例如滥用或误用止痛药。各种因素的汇聚表明，现在是时候使用像Pain CAS这样的临床工具了：(1)来自医疗政策制定者和支付者的压力越来越大，要求将护理、文档、风险评估和处方系统化；(2)公众对适当的疼痛治疗的需求；(3)公众、行业和监管机构对处方药滥用和滥用的担忧；(4)临床环境中越来越多地接受计算机评估和工具(包括EMR)；(5)对临床路径和疾病管理的兴趣越来越大，以提高护理的效率和质量，以及(6)越来越多地认识到从多个角度了解某些慢性疾病的重要性。尽管需要和之前的几次努力来开发电子疼痛评估，美国疼痛医学学会(AAPM)指出，还没有系统被广泛采用。根据我们先前开发和传播电子评估的工作以及为该系统增加价值的各种功能的创新组合，有充分理由认为将采用PARTING CAS。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PACH CAS系统，在实地试验中进行测试。在第二阶段，对疼痛专科诊所的患者进行的一项多水平、受控、随机的临床试验将测试疼痛CAS在仅限疼痛CAS评估的情况下和在治疗照常情况下对治疗过程和结果的影响。经过检验的假设是，疼痛CAS将：1)标准化慢性疼痛评估的文档，2)增加在就诊期间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。二次分析将检查疼痛CAS的使用与疼痛功能、情绪和药物滥用/滥用的改善有关的程度。拟议的疼痛CAS可能解决现有努力的局限性，以加强对慢性疼痛治疗的评估和实践。 与公共卫生相关：随着社会日益要求医疗专业人员处理慢性疼痛患者的复杂临床表现，医疗提供者获得标准化的计算机管理评估以及计算机治疗建议的好处变得越来越重要。全面、集成的疼痛评估面谈网络-临床咨询系统(Pain CAS)的成功开发和传播将在加强对慢性疼痛的评估和治疗方面走得更远，并被利益相关者视为非常有价值。我们相信，该产品具有巨大的商业可行性和公共卫生重要性，其创新的功能组合将克服困扰其他电子疼痛评估系统的采用障碍。

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.