As the population ages, an increasing number of older adults will present to emergency departments (EDs) for urgent and painful conditions. Preliminary studies demonstrate that older adults are less likely to receive analgesia in the ED setting. Over the last decade, pain care interventions in the outpatient and inpatient settings have had mixed success in improving the quality and patient satisfaction of pain care received. Interventions that provide clinical decision support (CDS) are a potential method to overcome this barrier and may present new assessment methods and management strategies for treating acute pain in older adults, thus significantly improve the quality of pain care delivered. The goals of this exploratory pilot study are to determine the feasibility of integrating electronic clinical decision support into routine clinical pain care for older adults in the ED setting and to determine whether or not such clinical decision support is efficacious in improving pain care outcomes for these patients. Utilizing a multistage study design that incorporates usability testing and quantitative research methodologies, data will be collected to assess the feasibility of integrating a CDS tool consisting of both an electronic pain care alert (ePCA) intervention and an embedded pain care algorithm into routine ED clinical care. A randomized comparative effectiveness trial evaluating the efficacy of these will then be studied to determine if the intervention improves the quality of pain care. The innovative use of CDS, never previously used to improve geriatric pain care in the ED setting, to prompt clinicians to provide acute pain care to older patients with complaints of severe (abdominal) pain (pain score 10 out of 0-10 pain scale) will be compared to control patients seen by clinicians not receiving the alerts (routine ED care). If effective, the implications of such an intervention will have broad implications and applicability for other acute pain-associated conditions specific to older adults, and with urgent conditions seen in multiple settings across and external to the ED including inpatient and outpatient settings.

Public Health Relevance

This exploratory study will evaluate the innovative use of a clinical decision support tool that consists of an automated electronic pain care alert and embedded pain care algorithms to improve acute pain care for older adults in the ED setting. If feasible and effective, such an intervention may have broad implications on improving not only the quality of geriatric pain care, but also general quality of care for elders in the ED setting.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21AG040734-02
Application #
8463441
Study Section
Biomedical Computing and Health Informatics Study Section (BCHI)
Program Officer
Eldadah, Basil A
Project Start
2012-05-01
Project End
2014-04-30
Budget Start
2013-05-15
Budget End
2014-04-30
Support Year
2
Fiscal Year
2013
Total Cost
$200,222
Indirect Cost
$82,097
Name
Icahn School of Medicine at Mount Sinai
Department
Emergency Medicine
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Hwang, Ula; Platts-Mills, Timothy F (2013) Acute pain management in older adults in the emergency department. Clin Geriatr Med 29:151-64