Millions of Americans undergo surgery every year, and postoperative pain is common and too often poorly managed. Poorly managed postoperative pain may cause severe functional impairment, adverse events, impaired care of the underlying diseases, transition to chronic pain, and decreased quality of life. Many controlled studies have demonstrated a variety of interventions that benefit postoperative pain, yet their application in a large and more diverse population is unknown, and a nationally endorsed, concise quality process metric for postoperative pain management does not exist. One roadblock is that postoperative pain and its related outcomes are complex. The gathering of evidence from electronic health data, which draw from and inform real-world practice, could bypass this roadblock and inform decisions leading to more effective and efficient postoperative pain management. This project seeks to measure quality of various care processes for postoperative pain, assess proposed evidence-based interventions from randomized controlled trials, lay the ground work for systematic pain-related research using EMRs, and produce population-based evidence for a nationally-endorsed postoperative pain management quality metric. To achieve these objectives, this project has three specific aims: (1) to develop standardized electronic definitions of pain-related care processes and outcomes (e.g. prolonged opioid use, readmission for pain, etc.); (2) to extract clinically meaningful data from both structured data and free text in electronic medical records (EMR) and examine the relationship between recommended care processes and outcomes for postoperative pain using EMRs; (3) to validate pain-related process-outcome relationships at a national level and to develop a National Quality Forum submission and evaluation form for a postoperative pain quality metric(s). This project will achieve these aims by developing data capture algorithms on Palo Alto Veterans Administration (VA) Healthcare data, refining algorithms at a tertiary academic hospital, and validating algorithms on the National VA healthcare system. Data will be identified and extracted from the EMR using an extended version of our validated data-mining workflow. Our established experience with quality metric development and NQF endorsement will facilitate the dissemination of this work. These approaches are the basis of a learning healthcare system, and the proposed research directly aligns with AHRQ's mission and goals to improve healthcare quality through health information technology and data resources.

Public Health Relevance

Ensuring that patients undergoing a surgical procedure receive high quality pain care management may not only improve the patients' healthcare experience and well-being, but also reduce overall healthcare costs. This project will examine the quality of pain management care provided to surgical patients, determine how variations in care influence patient outcomes, and develop a concise pain management quality metric(s) for national endorsement.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS024096-03
Application #
9302313
Study Section
Healthcare Patient Safety and Quality Improvement Research (HSQR)
Program Officer
Eldridge, Noel
Project Start
2015-09-01
Project End
2020-06-30
Budget Start
2017-07-01
Budget End
2018-06-30
Support Year
3
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Stanford University
Department
Surgery
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94304
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Hah, Jennifer; Hernandez-Boussard, Tina (2018) Defining Postoperative Opioid Needs Among Preoperative Opioid Users. JAMA Surg 153:689-690
Shaffer, Robyn; Backhus, Leah; Finnegan, Micaela A et al. (2018) Thirty-day unplanned postoperative inpatient and emergency department visits following thoracotomy. J Surg Res 230:117-124
Desai, Karishma; Carroll, Ian; Asch, Steven M et al. (2018) Utilization and effectiveness of multimodal discharge analgesia for postoperative pain management. J Surg Res 228:160-169
Curtin, Catherine M; Kenney, Debbie; Suarez, Paola et al. (2017) A Double-Blind Placebo Randomized Controlled Trial of Minocycline to Reduce Pain After Carpal Tunnel and Trigger Finger Release. J Hand Surg Am 42:166-174
Hernandez-Boussard, Tina; Graham, Laura A; Desai, Karishma et al. (2017) The Fifth Vital Sign: Postoperative Pain Predicts 30-day Readmissions and Subsequent Emergency Department Visits. Ann Surg 266:516-524
Tedesco, Dario; Gori, Davide; Desai, Karishma R et al. (2017) Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg 152:e172872
Tedesco, Dario; Asch, Steven M; Curtin, Catherine et al. (2017) Opioid Abuse And Poisoning: Trends In Inpatient And Emergency Department Discharges. Health Aff (Millwood) 36:1748-1753
Finnegan, Micaela A; Shaffer, Robyn; Remington, Austin et al. (2017) Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care. J Bone Joint Surg Am 99:1005-1012
Yanamadala, Swati; Morrison, Doug; Curtin, Catherine et al. (2016) Electronic Health Records and Quality of Care: An Observational Study Modeling Impact on Mortality, Readmissions, and Complications. Medicine (Baltimore) 95:e3332

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