Computerized PAINRelievelt for Adult Sickle Cell Disease

描述（由申请人提供）：未缓解的镰状细胞病（SC）疼痛是一种主要的健康问题，部分原因是疼痛评估困难和缺乏对已知有效控制疼痛的止痛药的了解。我们提出了一个两阶段的纵向研究，测试三个有效和可靠的触摸屏计算机化工具：a）疼痛评估数据收集和总结报告（PAINReportlt）; B）多媒体患者教育量身定制的患者的SC疼痛管理的误解（PainUCope）;和c）决策支持临床医生处方算法为基础的止痛治疗量身定制的患者的疼痛（PAINConsultN）。这三个项目被称为PAINRelievelt。在随机临床试验的第一阶段，我们将在DIG镰状细胞诊所接受护理的250名患者中使用前测试/后测试设计，以比较常规护理和PAINReportlt/PainUCope对a）患者结局（对疼痛、镇痛药依从性和疼痛强度的误解）和B）门诊提供者结局（疼痛记录）的影响。我们假设，在干预后三个月，计算机化的PAINReportlt/PainUCope组将减少误解和疼痛强度，并增加镇痛依从性，病历中的疼痛记录。在第二阶段，我们将在相同的250例镰状细胞患者中使用纵向重复测量设计，以比较随机分配其主治艾德或住院医生进行常规护理或PAINReportlt/PAINConsultN的效果。我们将比较常规护理和PAINReportlt/PAINConsultN对以下方面的长期影响：a）250例存在艾德访视风险或因疼痛性SC危象住院的患者的患者结局（疼痛发作）; B）34名UIC艾德和住院医生的艾德或住院医生结局（疼痛记录;处方止痛药的适当性）; c）系统结局（艾德访视次数和疼痛性SC危象住院天数）。我们假设，在实施干预两年后，PAINReportlt/PAINConsultN组将报告：a）疼痛发作减少; B）病历中的疼痛记录和适当镇痛处方数量增加; c）艾德访视次数和住院天数减少。调查结果将指导大规模实施这一创新的SC护理在整个美国。

DESCRIPTION (provided by applicant): Unrelieved sickle cell disease (SC) pain is a major health problem attributed in part to pain assessment difficulties and to lack of knowledge about analgesics known to be effective for pain control. We propose a two-phase longitudinal study testing three valid and reliable touch screen computerized tools: a) pain assessment data collection and summary report (PAINReportlt); b) multimedia patient education tailored to the patient's SC pain management misconceptions (PainUCope); and c) decision support for clinicians to prescribe algorithm-based analgesic therapies tailored to the patient's pain (PAINConsultN). Together, the three programs are known as PAINRelievelt. In the first phase of the randomized clinical trial, we will use a pre-test/post-test design in 250 patients receiving care at the DIG Sickle Cell Clinic to compare the effects of usual care and PAINReportlt/PainUCope on a) patient outcomes (misconceptions about pain, analgesic adherence, and pain intensity); and b) an outpatient provider outcome (pain documentation). We hypothesize that, three months after the intervention, the computerized PAINReportlt/PainUCope group will have decreased misconceptions and pain intensity and increased analgesic adherence, pain documentation in the medical record. In the second phase, we will use a longitudinal, repeated-measures design in the same 250 sickle cell patients to compare the effects of randomly assigning their attending ED or inpatient physicians to usual care or PAINReportlt/PAINConsultN. We will compare usual care and PAINReportlt/PAINConsultN for long-term effects on a) patient outcome (pain episodes) in 250 patients at risk for ED visits or hospitalization with painful SC crisis; b) ED or inpatient provider outcomes (pain documentation; appropriateness of prescribed analgesics) in 34 UIC ED and inpatient physicians; and c) system outcomes (number of ED visits and hospital days for painful SC crisis). We hypothesize that, two years after the intervention is implemented, the PAINReportlt/PAINConsultN group will report: a) decreased pain episodes; b) increased pain documentation in the medical record and number of appropriate analgesic prescriptions; and c) decreased number of ED visits and hospital days. Findings will guide large-scale implementation of this innovation in SC care throughout the USA.