Narasimhaswamy Smitha, Vedi Charanjit, Xavier Ylone, Tseng Chi-hong, Shine Daniel
Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA.
J Gen Intern Med. 2006 Jul;21(7):689-93. doi: 10.1111/j.1525-1497.2006.00457.x.
Historical undertreatment of pain among inpatients has resulted in a national requirement for pain practice standards.
We hypothesized that adoption/promulgation of practice standards in January 2003 at 1 suburban teaching hospital progressively increased compliance with those standards and decreased pain.
We retrospectively reviewed medical records each month during 2003, when pain standards were adopted with repeated, institution-wide, and nursing-unit-based interventions. Also, we reviewed discharges during 1 month in adjacent years.
We identified adult patients from 20 medical and surgical All-Payer Refined Disease Related Groupings (APRDRGs) in which opiate charges were most common in 2003. Among these, we considered patients actually receiving opiates and randomly chose equal numbers of matching subjects in each month of 2003. Matching was for APRDRG and complexity group. We also matched January 2003 discharges with those from January 2001, 2002, and 2004.
For each patient, we captured 3 variables measuring standards compliance: percentage pain observations reported numerically, number of observations, and median time to reassessment after opiates. We also captured 3 pain variables: median pain score, rate of improvement in pain score, and total opiates dispensed.
There were 360 qualifying discharges in 2003, and 75 in the other years. Numeric observations increased 15%, number of assessments 36%, and reassessment time decreased 60%. All changes were significant but occurred before standards implementation. Among pain measures, only rate of pain improvement changed, worsening slightly but significantly (-0.02 to -0.005 U/h), also before standards.
Implementation of pain practice standards affected neither practice nor pain.
住院患者疼痛治疗不足的情况在历史上一直存在，这促使国家制定了疼痛治疗实践标准。
我们假设，2003年1月在一家郊区教学医院采用/颁布的实践标准逐步提高了对这些标准的依从性，并减轻了疼痛。
我们回顾性地审查了2003年每月的病历，当时通过在全院和各护理单元反复进行干预来采用疼痛标准。此外，我们还审查了相邻年份中1个月的出院情况。
我们从20个医疗和外科全付费细化疾病相关分组（APRDRGs）中确定了成年患者，2003年这些分组中阿片类药物收费最为常见。在这些患者中，我们考虑了实际接受阿片类药物治疗的患者，并在2003年的每个月中随机选择了相等数量的匹配对象。匹配的是APRDRG和病情复杂程度分组。我们还将2003年1月的出院患者与2001年、2002年和2004年1月的出院患者进行了匹配。
对于每位患者，我们获取了3个衡量标准依从性的变量：以数字形式报告的疼痛观察百分比、观察次数以及使用阿片类药物后重新评估的中位时间。我们还获取了3个疼痛变量：疼痛评分中位数、疼痛评分改善率以及阿片类药物总用量。
2003年有360例符合条件的出院患者，其他年份有75例。数字观察增加了15%，评估次数增加了36%，重新评估时间减少了60%。所有变化均具有统计学意义，但均发生在标准实施之前。在疼痛指标中，只有疼痛改善率发生了变化，略有但显著恶化（从-0.02到-0.005 U/h），同样也是在标准实施之前。
疼痛治疗实践标准的实施既未影响治疗实践，也未减轻疼痛。
