Racial and Ethnic Disparities in Acute Pain Control

描述（由申请人提供）： 本研究的长期目标是确保所有到急诊科（艾德）就诊的疼痛患者接受适当的疼痛管理。 疼痛是美国艾德就诊的最常见原因。 有证据表明疼痛在艾德没有得到充分的治疗，亚特兰大和洛杉矶的研究表明，黑人和西班牙裔人比他们的白色同行更不可能接受足够的镇痛。 然而，尚不清楚在单个医院的回顾性病历审查中观察到的这些差异是否纯粹是局部现象，或者疼痛治疗不足是否与其他环境中的种族或民族更广泛地相关。 我们的目的是比较三组艾德患者的疼痛管理。西班牙裔、非西班牙裔、黑人、非西班牙裔白人，并评估观察到的疼痛管理与人种/种族之间的相关性是否独立于混杂变量，如年龄、性别、保险状况、教育。 我们还旨在评估种族/民族对疼痛管理充分性的影响是否可以通过（患者初始疼痛强度）或患者和医生之间的不一致来解释：1）种族/民族，B）医生对患者疼痛的感知。 为此，将在布朗克斯市中心的一家市立医院和一家志愿医院的急诊室招募285名长骨骨折患者。 将在基线、基线后1小时和出院时使用自我报告的疼痛[和非语言疼痛表达]收集疼痛数据。 还将收集关于给予的镇痛剂、患者和医生特征的数据。[We计划在2000年和2001年对长骨折进行图表审查，以便使用与所有先前发表的研究相同的设计来分析种族/民族与疼痛管理之间的关联。 回顾性和前瞻性结果的比较将加强从我们的发现中得出的推论。 前瞻性量化的差异急性疼痛管理的艾德的，这是人口和医疗保健系统之间的接口在危机时期，并定义预测治疗不足的疼痛将使医疗保健提供者，以提高护理质量的指导方针急性疼痛管理的ED。

DESCRIPTION (PROVIDED BY APPLICANT): The long-term objective of this research is to ensure that all patients in pain who present to the Emergency Department (ED) receive appropriate pain management. Pain is the most frequent reason for ED visits in the United States. There is evidence that pain is inadequately treated in the ED, and studies in Atlanta and Los Angeles suggests that Blacks and Hispanics are less likely to receive adequate analgesia than are their white counterparts. It is not clear, however, whether these difference, observed in retrospective chart reviews at single hospitals are purely local phenomena, or whether under-treatment of pain is more broadly associated with race or ethnicity in other settings. We aim to compare pain management among three groups of ED patients. Hispanics, non-Hispanic, Black, non-Hispanic Whites, and to assess whether the observed association between pain management and race/ethnicity is independent of confounding variable such as age, sex, insurance status, education. We also aim to assess whether the effect of race/ethnicity on adequacy of pain management is explained by (patient initial pain intensity) or by discordance between patients' and physicians': 1) race/ethnicity, b) physicians' perception of patient's pain. To do this (285) patients with long-bone fractures will be recruited in the EDs of one municipal and one voluntary hospital serving an inner-city, disadvantaged population in the Bronx. Data will be collected on pain using self-reported pain [and non-verbal pain expressions] at baseline, one hour post-baseline, and at discharge. Data on analgesics administered, patient and physician characteristics will also be gathered. [We plan to conduct a chart review of long fractures in 2000 and 2001 in order to analyze the association between race/ethnicity and pain management using the same design as all previously published studies. Comparison of the retrospective and prospective results will strengthen inferences that can be drawn from our findings.] Prospective quantification of disparities in acute pain management in ED's, which are the interface between the population and the health care system in times of crisis, and defining predictors of undertreatment of pain will enable health care providers to improve quality of care by developing guidelines for acute pain management in the ED.