Abstract

Background: Pain is not an inevitable or normal part of aging. However, chronic pain for geriatric patients is widespread, occurring in approximately 50% of community dwelling adults age 65 or over. Ineffectively treated chronic pain patients are at risk for poorer quality of life and functional decline. Risk for addiction to opioids prescribed for pain are increasingly recognized for geriatric pain patients. Evidence suggests that pain in geriatrics patients is common, challenging to assess, and requires a whole-person approach to diagnosis, treatment and monitoring. The goal of this study is to refine and test an approach to create contextual Patient Generated Data (PGD) profiles to guide geriatric pain care. Significance/Impact: Our proposed work will contribute to effective pain management and delivery of patient centered care. The proposed work aligns with many areas of high priority for VA including aging Veterans, pain management, informatics, and whole health and has implications for the redesign of the Electronic Health Record. Innovation: This study includes an innovative approach to patient centered care by examining contextual PGD contribution in depth in a vulnerable Veteran population with chronic pain. Specific Aims: Aim 1: Prioritize content for contextual PGD profiles to support patient centered care for geriatric Veterans with chronic pain. Aim 2: Develop a prototype contextual PGD display and evaluate its usability. Aim 3: Examine the impact of contextual PGD profile displays on patient adherence, pain function, satisfaction, and shared decision making in a randomized trial. Methodology: The study population is Veterans with chronic pain, caregivers involved in their daily lives, and the primary care clinicians who treat these Veterans in primary care or geriatrics clinics in both urban and rural settings. Clinicians will include physicians, nurse practitioners, nurses, social workers, psychologists and other relevant primary care team members. This is a mixed methods study incorporating focus groups with clinicians and with Veteran patients and caregivers and systematic evaluation of iterative contributions of contextual PGD to develop and optimize methods for Veterans to contribute contextual PGD An additional group of Patient-Aligned Care Team members will engage in a card sort exercise, reporting in more detail on the relevance of particular contextual PGD elements for clinical care. There will be a randomized comparison at the patient level comparing patient visits that include contextual PGD and those that do not. The primary outcome is adherence to the pain management regimen. Secondary outcomes include pain function, patient satisfaction, and shared decision making in the visit. Next Steps/Implementation: Our project includes multiple assessments designed to improve collection of contextual PGD to inform future implementation, working closely with our operational partners the Offices of Healthcare Informatics, Connected Care, Connected Health and Patient Centered Care and Cultural Transformation.

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DRA: Aging, Older Veterans' Health and Care

DRE: TRL - Applied/Translational, Treatment - Observational, Treatment - Implementation

Keywords: Data Management, Electronic Health Record, Information Management, Technology Development

MeSH Terms: None at this time.