Background: This pilot project assesses the feasibility of collecting Veteran ED pain care data. Information gathered from this project will provide preliminary data to support the long-term goal of developing an electronic medical record abstraction technique to allow future researchers and quality improvement methods to accurately abstract information on Veteran ED pain care. The development of such a pain care informatics abstraction tool is aligned with Veterans Health Administration (VHA) clinical and research priorities. Pain has been identified as a quality of care priority in the VHA with the 'pain as a 5th vital sign' initiative serving as a useful model to explore emergency department care in the patient population. Healthcare initiatives to improve the quality of pain management and processes involved with pain care across medical settings have gradually increased staff awareness of the need to address pain. These gains in the quality of pain assessment, however, have not been shown to improve the overall level of reported pain intensity. It is also not well known how these changes have translated into improvements in pain care management and outcomes. By examining the quality of ED pain care veterans receive, the VHA may better understand the current quality of pain care delivered and target gaps and areas requiring improvement in clinical care and patient outcomes with future interventions. As a VHA HSR&D methodologic priority, healthcare informatics is an area where the groundwork for veteran clinical research is now being established. This coupled with the VHAs longstanding electronic medical record, university affiliated investigators, centralized clinical databases, and integrated national system create an ideal environment for automated monitoring and investigation of veteran quality of pain care in the ED setting. The development of a pain care informatics abstraction tool is aligned with VHA clinical and research priorities. It is not known, however, if the pain care measures collected for the NIA project can be easily applied to VA data, what the data types are, and where the data sources may be located. Objectives:
The specific aims of this project are: 1. to assess the feasibility of extracting process of pain care measures with human record review of VHA ED medical records, 2. to gather information on sources and types of data needed for (future) extracting process of pain care measures with electronic abstraction of data from VHA sources, and 3. to provide recommendations on improving/modifying/structuring VA data for accurate and consistent electronic abstraction of process of pain care data (e.g., implementing templates for missing data). Project methods: To achieve these objectives, we will conduct both a feasibility and an exploratory study. The feasibility study will consist of retrospective, human review of a sample cohort of ED medical records at both James J. Peters and West Haven VA for the pain care measure used in the NIA study. The exploratory study will investigate whether these measures also exist in local and national VA databases, what type of data they exists as, if the data can be accessed, and how these data are organized. A comparison of ease, format, and types of data collected from structured data sources will be made against the data collected from human medical record review. This information will allow us to provide recommendations on how to potentially improve how process of pain care data are recorded and stored at the VA, but also support proposals to develop an electronic pain care abstraction tool (EPCAT) for use on VA medical records. This in turn may support the implementation of decision support for improving the quality of pain care in the ED for veteran patients.

Public Health Relevance

By examining the quality of emergency department (ED) pain care veterans receive, the Veterans Health Administration (VHA) may better understand and improve clinical care and patient outcomes with targeted future interventions. Electronic monitoring of pain care would allow for an easier and cost efficient method of evaluating the quality of pain care and its outcomes. The development of such an abstraction tool is not only aligned with VHA HSR&D methodologic priorities in healthcare informatics, but also would advance clinical and research initiatives to further improve system-wide veteran ED pain care in the VHA.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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James J Peters VA Medical Center
United States
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