Multifaceted Interventions to Ameliorate Pain/Symptoms

描述(由申请人提供)：疼痛仍然是养老院中虚弱的老年人发病的一个重要原因。高达83%的养老院居民抱怨疼痛。养老院居民对疼痛的抱怨往往得不到承认或没有得到适当的治疗。大量的科学证据证明，治疗疼痛的药理和非药理方法是现成的。利用持续质量改进的研究，包括最近由老年学和健康护理研究中心与国际扶轮质量伙伴合作完成的一项研究，已经影响了护士在评估、记录和使用非药物治疗疼痛方面的行为。这项研究减少了33%的疼痛。然而，我们的干预并没有显著影响医生的禁忌行为。根据护士协调员和其他研究人员的汇报，护士与医生的沟通和医生知识的缺乏是适当疼痛管理的两个重要障碍。在此R21应用程序中，我们建议开发和试点测试基于个人数字助理(PDA)的决策支持干预，用于长期护理中的疼痛管理。这一决策支持将协助护士进行疼痛评估，提供治疗建议(S)，并打印一份总结报告，供医生办公室固定。将利用美国老年学会、美国医学主任协会和AHRQ疼痛管理指南的现有指南以及专家小组的建议来制定决策支持工具。在这项干预措施的发展过程中，我们将与最终用户(长期护理护士和医生)进行焦点小组，利用认知测试，并进行为期六个月的试点测试，以检查国际扶轮的两家养老院(一个学术基础NH和一个社区基础NH)决策支持应用的使用情况。评估将收集有关决策建议的时间、PDA应用程序的可接受性、建议是否被使用以及使用决策支持前后报告的疼痛程度的信息。如果我们成功开发了这种干预措施，R01研究应用程序将准备进行一项分组随机试验，以确定当这种干预措施与快速循环持续质量改进干预措施相结合时，是否会改善疼痛管理的质量。

DESCRIPTION (provided by applicant): Pain remains an important cause of morbidity for frail, older persons in nursing homes. As high as 83% of nursing home residents voice complaints of pain. Often, nursing home residents' complaints of pain are not recognized or not appropriately treated. A substantial scientific evidence base attests to readily available pharmacological and non-pharmacological modalities to treat pain. Research utilizing continuous quality improvement, including a recently completed study by Center for Gerontology and Health Care Research in cooperation with RI Quality Partners, has impacted on nurses' behavior in the assessment, documentation, and the use of non-pharmacological treatment of pain. This study resulted in 33% reduction in pain. However, our intervention did not significantly impact on physician proscribing behavior. Based on debriefing of nurse coordinators and others research, nurse-physician communication and physicians' lack of knowledge are two important barriers to appropriate pain management. In this R21 application, we propose to develop and pilot test a Personal Digital Assistant (PDA) based decision support intervention for pain management in long term care. This decision support will assist the nurses in conducting a pain assessment, provide treatment recommendation(s), and print a summary report to be fixed to the physician office. Existing guide lines from the American Geriatric Society, American Medical Director Association, and AHRQ pain management guidelines as well as the advice of expert panel will be utilized to formulate decision support tool. In the development of this intervention, we will conduct focus groups with end users (long term care nurses and physicians), utilize cognitive testing, and conduct a six month pilot test that will examine the use of the decision support application in two nursing homes in RI (one academic base NH and one community base NH). An evaluation will collect information on the time to decision recommendation, acceptability of the PDA application, whether recommendations were utilized, and the reported level of pain prior to and after the use of decision support. If we are successful in development of this intervention, a R01 research application will be prepared to conduct a block randomized trial of whether this intervention when combined with the rapid cycle continuous quality improvement intervention improves quality of pain management.