Gordon Debra B, Pellino Teresa A, Miaskowski Christine, McNeill Jeanette Adams, Paice Judith A, Laferriere Daniel, Bookbinder Marilyn
University of Wisconsin Hospital and Clinics, 600 Highland Avenue, F6/121-1535, Madison, WI 53792, USA.
Pain Manag Nurs. 2002 Dec;3(4):116-30. doi: 10.1053/jpmn.2002.127570.
Quality measurement in health care is complex and in a constant state of evolution. Different approaches are necessary depending on the purpose of the measurement (e.g., accountability, research, improvement). Recent changes in health care accreditation standards are driving increased attention to measurement of the quality of pain management for improvement purposes. The purpose of this article is to determine what indicators are being used for pain quality improvement, compare results across studies, and provide specific recommendations to simplify and standardize future measurement of quality for hospital-based pain management initiatives. Pain management quality improvement monitoring experience and data from 1992 to 2001 were analyzed from 20 studies performed at eight large hospitals in the United States. Hospitals included: the University of Wisconsin Hospital and Clinics, Madison; Texas Medical Center, Houston; McAllen Medical Center, McAllen, TX; San Francisco General Hospital, San Francisco; Rush-Presbyterian-St. Luke's Medical Center and Northwestern Memorial Hospital, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York; and Kaiser Sunnyside Medical Center of Kaiser Permanente Northwest, Clackamas, OR. Analyses of data led to consensus on six quality indicators for hospital-based pain management. These indicators include: the intensity of pain is documented with a numeric or descriptive rating scale; pain intensity is documented at frequent intervals; pain is treated by a route other than intramuscular; pain is treated with regularly administered analgesics, and when possible, a multimodal approach is used; pain is prevented and controlled to a degree that facilitates function and quality of life; and patients are adequately informed and knowledgeable about pain management. Although there are no perfect measures of quality, longitudinal data support the validity of a core set of indicators that could be used to obtain benchmark data for quality improvement in pain management in the hospital setting.
医疗保健中的质量测量复杂且处于不断演变的状态。根据测量目的（例如问责、研究、改进），需要采用不同的方法。近期医疗保健认证标准的变化促使人们更加关注出于改进目的的疼痛管理质量测量。本文的目的是确定用于疼痛质量改进的指标，比较各项研究的结果，并提供具体建议，以简化和规范未来基于医院的疼痛管理举措的质量测量。对美国八家大型医院开展的20项研究中1992年至2001年的疼痛管理质量改进监测经验和数据进行了分析。这些医院包括：威斯康星大学医院及诊所，麦迪逊；德克萨斯医疗中心，休斯顿；麦卡伦医疗中心，德克萨斯州麦卡伦；旧金山综合医院，旧金山；拉什长老会圣卢克医疗中心和西北纪念医院，伊利诺伊州芝加哥；纪念斯隆凯特琳癌症中心，纽约；以及凯撒永久医疗集团西北分部的凯撒桑尼赛德医疗中心，俄勒冈州克拉卡马斯。数据分析得出了基于医院的疼痛管理的六个质量指标的共识。这些指标包括：用数字或描述性评级量表记录疼痛强度；定期记录疼痛强度；采用肌肉注射以外的途径治疗疼痛；使用定期给药的镇痛药进行治疗，并且尽可能采用多模式方法；预防和控制疼痛，使其程度便于功能和生活质量的改善；患者充分了解疼痛管理并具备相关知识。尽管没有完美的质量衡量标准，但纵向数据支持了一组核心指标的有效性，这些指标可用于获取医院环境中疼痛管理质量改进的基准数据。
