Pragmatic Use of PAIN-Advanced Dementia Scale in Emergency Departments

The University of Chicago

Status: Completed

Conditions: Pain in Advanced Dementia Scale; Hip Pain; Emergency Department Patient; Dementia

Treatments: Other: PAINAD EHR Prompt

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06370572

U54AG063546 (U.S. NIH Grant/Contract)

CIRB23-1162

Details and patient eligibility

About

The purpose of this study is to learn if the Pain in Advanced Dementia (PAINAD) scale can improve emergency pain care in persons living with dementia (PLWD). It is hypothesized that a PAINAD electronic health record (EHR) prompt that appears to emergency department (ED) staff will enable them to accurately assess pain levels and lead to better pain treatment for PLWD.

Full description

This is a pragmatic pilot for a Stage IV effectiveness, embedded pragmatic clinical trial (ePCT) studying the feasibility of PAINAD assessment implementation via simple EHR prompts for PLWD presenting to the ED with hip pain at the University of Chicago Medicine (UCM) and the University of North Carolina at Chapel Hill (UNC-CH). Identification of subjects with hip pain and dementia contains the level of specificity needed for a pragmatic trial, and occurs on ED arrival, prompting an electronic health record clinical decision support (CDS).

The Pain in Advance Dementia (PAINAD) Score is a behavioral score based on observation of the person. The score depends on observation of five behaviors, breathing, negative vocalizations, facial expressions, body language, and consolability. Each observed behavior is scored from zero = none, to two = most, for a total score from zero to ten.

The design is an interrupted time series intervention, which allows a pre- and post-intervention assessment of the effect of PAINAD scale. Pre-intervention data from most immediate year to date prior to the intervention start defines the baseline state. The intervention, the EHR prompt to document the PAINAD first on patient arrival to the ED treatment area, and second one hour after delivery of first pain treatment. Prospective evaluation of EHR data will be used to evaluate use of the PAINAD.

Enrollment: 714 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients greater than or equal to 65 years old
• ED arrival complaint of hip pain
• History of dementia by past medical history or problem list in EHR

Exclusion criteria

• Patients do not meet inclusion criteria

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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714 participants in 2 patient groups

Pre-implementation

No Intervention group

Description:

PLWD presenting to the ED with reported hip pain in the year preceding implementation of the PAINAD EHR prompt

Post-implementation

Experimental group

Description:

PLWD presenting to the ED with reported hip pain in the 10 months following implementation of the PAINAD EHR prompt

Treatment:

Other: PAINAD EHR Prompt