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. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL078536-03
Application #
7457824
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Werner, Ellen
Project Start
2006-07-01
Project End
2010-06-30
Budget Start
2008-07-01
Budget End
2009-06-30
Support Year
3
Fiscal Year
2008
Total Cost
$684,082
Indirect Cost
Name
University of Illinois at Chicago
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
098987217
City
Chicago
State
IL
Country
United States
Zip Code
60612
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