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Wang WY, Chu CM, Wu YS, Sung CS, Ho ST, Pan HH, Wang KY. Evaluation of the pain intensity differences among hospitalized cancer patients based on a nursing information system. PLoS One 2019; 14:e0222516. [PMID: 31553746 PMCID: PMC6760775 DOI: 10.1371/journal.pone.0222516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/30/2019] [Indexed: 11/19/2022] Open
Abstract
Evaluating the absolute difference in pain intensity and the percentage difference in pain intensity could facilitate an understanding of pain reduction among cancer patients during repeated hospitalizations. Examinations of the absolute differences in pain intensity and the percentage differences in pain intensity according to the worst pain intensity and last evaluated pain intensity before discharge are lacking. The aim of this study was to evaluate the absolute and percentage difference in pain intensities among cancer patients with moderate or severe pain from their 1st to 18th hospitalizations from 2011–2013. A population-based retrospective cohort study was conducted. Pain intensity was assessed using scales and was recorded in a nursing information system. The absolute and percentage difference in pain intensities were examined via the one-sample Kolmogorov-Smirnov test, and group differences in moderate or severe pain were evaluated with the Mann-Whitney U test. For moderate pain patients, the mean absolute difference in pain intensity was 1.52, and the percentage difference in pain intensity was 29.0%; both these values were significant. More significant changes in the absolute and percentage difference in pain intensities were associated with severe pain patients. Both the average absolute difference in pain intensity (3.09) and the percentage difference in pain intensity (38.5%) in patients with severe pain were significantly higher than the average absolute difference in pain intensity (1.52) and the percentage difference in pain intensity (29.0%) in patients with moderate pain. Cancer patients with moderate and severe pain experienced pain reductions of approximately 30% and 40%, respectively. Early pain management intervention in patients with severe pain is necessary to achieve an obvious analgesic effect, and the formula of the percentage difference in pain intensity should be incorporated into the nursing information system to alert clinicians for early detection of the effectiveness of cancer pain management.
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Affiliation(s)
- Wei-Yun Wang
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Syuan Wu
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Sung Sung
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shung-Tai Ho
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsueh-Hsing Pan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Kwua-Yun Wang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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Pryzbylkowski P, Ashburn MA. The Pain Medical Home: A Patient-Centered Medical Home Model of Care for Patients with Chronic Pain. Anesthesiol Clin 2016; 33:785-93. [PMID: 26610630 DOI: 10.1016/j.anclin.2015.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic pain affects an estimated 100 million people a year in the United States and costs society anywhere from $560 to $635 billion annually. The patient-centered medical home and the patient-centered medical home-neighbor models of care have been advocated to improve patient outcomes. These models of care advocate improved coordination of care within the primary care and specialty care setting. The authors present the patient-centered medical home model of care and suggest how this model of care might be used to improve patient outcomes for patients with chronic pain.
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Affiliation(s)
- Peter Pryzbylkowski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
| | - Michael A Ashburn
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Standardization of care that is derived from analysis of outcomes data can lead to improvements in quality and efficiency of care. The outcomes data should be validated, standardized, and integrated into ongoing patient care with minimal burden on the patient and health care team. This article describes the organization and workflow of a chronic pain clinic registry designed to collect and analyze patient data for quality improvement and dissemination. Future efforts in using mobile technology and integrating patient-reported outcome data in the electronic health records have the potential to offer new and improved models of comprehensive pain management.
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Affiliation(s)
- Neel Mehta
- Department of Anesthesiology, Weill Cornell Pain Medicine, Weill Cornell Medical College, 1305 York Avenue, 10th Floor, New York, NY 10021, USA
| | - Charles E Inturrisi
- Department of Pharmacology, Weill Cornell Medical College, 1300 York Avenue, LC-519A, New York, NY 10065, USA
| | - Susan D Horn
- Department of Population Health Sciences, Health System Innovation and Research Division, University of Utah, School of Medicine, 295 Chipeta Way, Room 1N461, Salt Lake City, UT 84108, USA
| | - Lisa R Witkin
- Department of Anesthesiology, Weill Cornell Pain Medicine, Weill Cornell Medical College, 1305 York Avenue, 10th Floor, New York, NY 10021, USA.
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Wang WY, Chu CM, Sung CS, Ho ST, Wu YS, Liang CY, Wang KY. Using a New Measurement to Evaluate Pain Relief Among Cancer Inpatients with Clinically Significant Pain Based on a Nursing Information System: A Three-Year Hospital-Based Study. PAIN MEDICINE 2016; 17:2067-2075. [PMID: 26995798 DOI: 10.1093/pm/pnw026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Developing a new measurement index is the first step in evaluating pain relief outcomes. Although the percentage difference in pain intensity (%PID) is the most popular indicator, this indicator does not take into account the goal of pain relief. Therefore, the aims of this study were to develop a pain relief index (PRI) for outcome evaluation and to examine the index using demographic characteristics of cancer inpatients with clinically significant pain. DESIGN Retrospective cohort study. SETTING A national hospital. SUBJECTS All cancer inpatients. METHODS Pain intensity was assessed using a numerical rating scale, a faces pain scale or the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Tool. Using a nursing information system, a pain score database containing data from 2011 through 2013 was analyzed. RESULTS Cancer patients representing 93,812 hospitalizations were considered in this study. We focused on cancer patients for whom the worst pain intensity (WPI) was ≥ 4 points. PRI values of -62.02% to -72.55% were observed in the WPI ≥ 7 and 4 ≤ WPI ≤ 6 groups. Significant (P < 0.05) effects on PRI values were observed among patients who were > 65 years old, those who were admitted to the medicine or gynecology and those who had a hospital stay > 30 days. CONCLUSION This hospital-based study demonstrated that the PRI is an effective and valid measure for evaluating outcome data using an electronic nursing information system. We will further define the meaningful range of percentage difference in PRI from various perspectives.
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Affiliation(s)
- Wei-Yun Wang
- *Graduate Institute of Medical Sciences, National Defense Medical Center and Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Sung Sung
- Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shung-Tai Ho
- Hospital Division, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Syuan Wu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Yu Liang
- Graduate Institute of Medical Sciences, and School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Kwua-Yun Wang
- Department of Nursing, Taipei Veterans General Hospital and Graduate Institute of Medical Sciences, and School of Nursing, National Defense Medical Center, Taipei, Taiwan
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Wang WY, Ho ST, Wu SL, Chu CM, Sung CS, Wang KY, Liang CY. Trends in Clinically Significant Pain Prevalence Among Hospitalized Cancer Patients at an Academic Hospital in Taiwan: A Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e2099. [PMID: 26735526 PMCID: PMC4706246 DOI: 10.1097/md.0000000000002099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/20/2015] [Accepted: 10/26/2015] [Indexed: 11/26/2022] Open
Abstract
Clinically significant pain (CSP) is one of the most common complaints among cancer patients during repeated hospitalizations, and the prevalence ranges from 24% to 86%. This study aimed to characterize the trends in CSP among cancer patients and examine the differences in the prevalence of CSP across repeated hospitalizations. A hospital-based, retrospective cohort study was conducted at an academic hospital. Patient-reported pain intensity was assessed and recorded in a nursing information system. We examined the differences in the prevalence of worst pain intensity (WPI) and last evaluated pain intensity (LPI) of ≥ 4 or ≥ 7 points among cancer inpatients from the 1st to the 18th hospitalization. Linear mixed models were used to determine the significant difference in the WPI and LPI (≥ 4 or ≥ 7 points) at each hospitalization. We examined 88,133 pain scores from the 1st to the 18th hospitalization among cancer patients. The prevalence of the 4 CSP types showed a trend toward a reduction from the 1st to the 18th hospitalization. There was a robust reduction in the CSP prevalence from the 1st to the 5th hospitalization, except in the case of LPI ≥ 7 points. The prevalence of a WPI ≥ 4 points was significantly higher (0.240-fold increase) during the 1st hospitalization than during the 5th hospitalization. For the 2nd, 3rd, and 4th hospitalizations, there was a significantly higher prevalence of a WPI ≥ 4 points compared with the 5th hospitalization. We also observed significant reductions in the prevalence of a WPI ≥ 7 points during the 1st to the 4th hospitalizations, an LPI ≥ 4 points during the 1st to the 3rd hospitalizations, and an LPI ≥ 7 points during the 1st to the 2nd hospitalization. Although the prevalence of the 4 CSP types decreased gradually, it is impossible to state the causative factors on the basis of this observational and descriptive study. The next step will examine the factors that determine the CSP prevalence among cancer patients. However, based on these positive findings, we can provide feedback to nurses, physicians, and pharmacists to empower them to be more committed to pain management.
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Affiliation(s)
- Wei-Yun Wang
- From the Graduate Institute of Medical Sciences (W-YW, K-YW, C-YL), National Defense Medical Center; Department of Nursing (W-YW), Tri-Service General Hospital; Department of Anesthesiology (S-TH, C-SS), Taipei Veterans General Hospital; Taiwan Research Association of Health Care (S-LW); School of Public Health (C-MC), National Defense Medical Center; School of Medicine (C-SS), National Yang-Ming University; Department of Nursing (K-YW), Taipei Veterans General Hospital; and School of Nursing (K-YW, C-YL), National Defense Medical Center, Taipei, Taiwan
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Lakha SF, Pennefather P, Badr HE, Mailis-Gagnon A. Health Services for Management of Chronic Non-Cancer Pain in Kuwait: A Case Study Review. Med Princ Pract 2015; 25 Suppl 1:29-42. [PMID: 26595816 PMCID: PMC5588520 DOI: 10.1159/000442526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 11/17/2015] [Indexed: 11/21/2022] Open
Abstract
The experience of chronic pain is universal, yet pain management services delivered by health professionals vary substantially, depending on the context and patient. This review is a part of a series that has examined the issue of chronic non-cancer pain services and management in different global cities. The review is structured as a case study of the availability of management services for people living with chronic non-cancer pain within the context of the Kuwaiti health systems, and the cases are built from evidence in the published literature identified through a comprehensive review process. The evolution of the organizational structure of the public and private health systems in Kuwait is described. These are discussed in terms of their impact on the delivery of comprehensive chronic pain management service by health professionals in Kuwait. This review also includes a description of chronic pain patient personas to highlight expected barriers as well as compliance issues with services likely to be encountered in Kuwait. The case study analysis and persona descriptions illustrate a need to move beyond pain symptom management towards considering the entire person and his/her individual experience of pain such that health care success is judged by enhancement of patient well-being rather than access to services. A road map for improving integrative chronic pain management in Kuwait is discussed.
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Affiliation(s)
| | | | - Hanan E. Badr
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Angela Mailis-Gagnon
- University of Toronto, Safat, Kuwait
- Comprehensive Pain Toronto, Krembil Neuroscience Centre, University Health Network, Toronto, Ont., Canada
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Fleisher LA, Lee TH. Anesthesiology and anesthesiologists in the era of value-driven health care. Healthcare (Basel) 2015; 3:63-6. [DOI: 10.1016/j.hjdsi.2015.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 12/30/2014] [Accepted: 01/21/2015] [Indexed: 12/19/2022] Open
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Juckett DA, Davis FN, Gostine M, Reed P, Risko R. Patient-reported outcomes in a large community-based pain medicine practice: evaluation for use in phenotype modeling. BMC Med Inform Decis Mak 2015; 15:41. [PMID: 26017305 PMCID: PMC4446111 DOI: 10.1186/s12911-015-0164-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/20/2015] [Indexed: 11/11/2022] Open
Abstract
Background An academic, community medicine partnership was established to build a phenotype-to-outcome model targeting chronic pain. This model will be used to drive clinical decision support for pain medicine in the community setting. The first step in this effort is an examination of the electronic health records (EHR) from clinics that treat chronic pain. The biopsychosocial components provided by both patients and care providers must be of sufficient scope to populate the spectrum of patient types, treatment modalities, and possible outcomes. Methods The patient health records from a large Midwest pain medicine practice (Michigan Pain Consultants, PC) contains physician notes, administrative codes, and patient-reported outcomes (PRO) on over 30,000 patients during the study period spanning 2010 to mid-2014. The PRO consists of a regularly administered Pain Health Assessment (PHA), a biopsychosocial, demographic, and symptomology questionnaire containing 163 items, which is completed approximately every six months with a compliance rate of over 95 %. The biopsychosocial items (74 items with Likert scales of 0–10) were examined by exploratory factor analysis and descriptive statistics to determine the number of independent constructs available for phenotypes and outcomes. Pain outcomes were examined both in the aggregate and the mean of longitudinal changes in each patient. Results Exploratory factor analysis of the intake PHA revealed 15 orthogonal factors representing pain levels; physical, social, and emotional functions; the effects of pain on these functions; vitality and health; and measures of outcomes and satisfaction. Seven items were independent of the factors, offering unique information. As an exemplar of outcomes from the follow-up PHAs, patients reported approximately 60 % relief in their pain. When examined in the aggregate, patients showed both a decrease in pain levels and an increase in coping skills with an increased number of visits. When examined individually, 80-85 % of patients presenting with the highest pain levels reported improvement by approximately two points on an 11-point pain scale. Conclusions We conclude that the data available in a community practice can be a rich source of biopsychosocial information relevant to the phenotypes of chronic pain. It is anticipated that phenotype linkages to best treatments and outcomes can be constructed from this set of records.
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Affiliation(s)
- David A Juckett
- Biomedical Research Informatics Core, Clinical and Translational Sciences Institute, Michigan State University, West Fee Hall, East Lansing, MI, USA.
| | - Fred N Davis
- Michigan Pain Consultants, PC, ProCare Systems, Inc., Grand Rapids, MI, USA
| | - Mark Gostine
- Michigan Pain Consultants, PC, ProCare Systems, Inc., Grand Rapids, MI, USA
| | - Philip Reed
- Biomedical Research Informatics Core, Clinical and Translational Sciences Institute, Michigan State University, West Fee Hall, East Lansing, MI, USA
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