Racial and Ethnic Disparities in Acute Pain Control

描述(申请人提供)：这项研究的长期目标是确保所有到急诊科(ED)就诊的疼痛患者都得到适当的疼痛治疗。疼痛是ED在美国就诊的最常见原因。有证据表明，急诊室对疼痛的治疗不够充分，亚特兰大和洛杉矶的研究表明，黑人和拉美裔美国人比白人更不可能接受足够的止痛。然而，尚不清楚在单一医院的回顾图表审查中观察到的这些差异是否纯粹是局部现象，或者在其他环境中，疼痛治疗不足是否与种族或民族有更广泛的联系。 我们的目标是比较三组ED患者的疼痛管理。研究对象包括西班牙裔、非西班牙裔、黑人和非西班牙裔白人，并评估观察到的疼痛管理与种族/族裔之间的联系是否独立于年龄、性别、保险状况、教育程度等混杂变量。我们还旨在评估种族/民族对疼痛管理充分性的影响是由(患者初始疼痛强度)还是患者与医生之间的不协调来解释的：1)种族/民族，b)医生对患者疼痛的感知。为此，(285名)长骨骨折患者将被招募到一家市政医院和一家志愿医院的急诊室，为布朗克斯市中心的弱势群体提供服务。在基线、基线后一小时和出院时，将使用自我报告的疼痛[和非语言疼痛表达]收集关于疼痛的数据。还将收集有关所用止痛药、患者和医生特征的数据。[我们计划在2000年和2001年对长骨折进行图表审查，以分析种族/民族和疼痛控制之间的联系，使用与所有先前发表的研究相同的设计。回顾结果和预期结果的比较将加强从我们的调查结果中得出的推论。] 对急诊室急性疼痛管理方面的差异进行前瞻性量化，这是危机时期人口和医疗保健系统之间的接口，并确定疼痛治疗不足的预测因素，将使医疗保健提供者能够通过制定急诊室急性疼痛管理指南来提高护理质量。

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.