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Ameliorating Pain in Nursing Homes: A Collaborative Quality-Improvement Project

Authors

  • Rosa R. Baier MPH,

    1. From the *Department of Community Health, Division of Medicine, and Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island§Quality Partners of Rhode Island, Providence, Rhode Island
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  • David R. Gifford MD, MPH,

    1. From the *Department of Community Health, Division of Medicine, and Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island§Quality Partners of Rhode Island, Providence, Rhode Island
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  • Gail Patry RN,

    1. From the *Department of Community Health, Division of Medicine, and Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island§Quality Partners of Rhode Island, Providence, Rhode Island
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  • Sara M. Banks MPH, PhD,

    1. From the *Department of Community Health, Division of Medicine, and Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island§Quality Partners of Rhode Island, Providence, Rhode Island
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  • Therese Rochon RNP, MSN, MA,

    1. From the *Department of Community Health, Division of Medicine, and Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island§Quality Partners of Rhode Island, Providence, Rhode Island
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  • Debra DeSilva BA,

    1. From the *Department of Community Health, Division of Medicine, and Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island§Quality Partners of Rhode Island, Providence, Rhode Island
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  • Joan M. Teno MD, MS

    1. From the *Department of Community Health, Division of Medicine, and Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island§Quality Partners of Rhode Island, Providence, Rhode Island
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  • Presented at the American Geriatrics Society Annual Meeting, Washington, DC, May 8–12, 2002. Funded by the Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services and The Robert Wood Johnson Foundation.

  • The analyses upon which this publication are based were performed under Contract 500–99-RI02, “Utilization and Quality Control Peer Review for the State of Rhode Island,” sponsored by CMS, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. The ideas presented in this article are those of the authors, and do not reflect the views of the authors' employers, the CMS, the Robert Wood Johnson Foundation, or Brown University. This article is a direct result of the Health Care Quality Improvement Program initiated by the CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.

Rosa R. Baier, MPH, Quality Partners of Rhode Island, 235 Promenade Street, Suite 500, Box 18, Providence, RI 02908. E-mail: RBaier@riqio.sdps.org

Abstract

Objectives: To evaluate a multifaceted intervention to improve pain-management processes of care and outcomes in nursing homes.

Design: Quasi-experimental, pretest/posttest.

Setting: Nursing homes in Rhode Island.

Participants: Twenty-one facilities.

Intervention: This project used a multifaceted collaborative intervention involving audit and feedback of pain management, education, training, coaching using rapid-cycle quality-improvement techniques, and inter-nursing home collaboration.

Measurements: Pain-management processes of care and outcomes, measured using chart review and the Minimum Data Set.

Results: Of 21 facilities, 17 completed the project. Postintervention, nursing homes increased the use of appropriate pain assessments (3.9% vs 43.8%, P<.001), pain intensity scales (15.6% vs 73.9%, P<.001), and nonpharmacological treatments (40.5% vs 81.9%, P<.001). Prescriptions of World Health Organization Step II or Step III pain medications for residents with daily moderate or severe pain showed trends towards improvement (40.8% vs 50.6%, P=.057), but prescription of any pain medication (93.3% vs 94.6%, P=.710), change in pain medication (29.0% vs 30.1%, P=.386), and prescription of pain medications on a regularly scheduled basis (67.9% vs 69.5%, P=.370) did not. There was a 41.1% reduction in prevalence of pain (12.2% vs 7.2%, P=.032) between the pre- and postintervention time periods in the nursing homes that completed the project, whereas all the other facilities in Rhode Island (n=72) had only a 12.1% reduction (12.7% vs 11.2%, P=.286) during the same period.

Conclusion: A multifaceted intervention improved pain-management process and outcome measures in nursing homes.

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