Acute Pain, Pain, Postoperative Pain
Conditions
Keywords
patient readmission, pain relief units, pain centers, multidisciplinary pain clinics, multidisciplinary pain centers, pain clinics, hospital readmission, emergencies, emergency medicine, critical care, emergency treatment, opioid, acute pain service
Brief summary
Pain is a symptom that drives hospital admissions, and pain management is required by most patients during their hospital stay. Further, the use of medications such as opioids can lead to upward-spiraling doses, especially among chronic pain patients whose resource utilization rates are high. Many initiatives aim to reduce the costs of these high-resource utilizing patients. One exciting aspect of improving the management of pain is that this may help prevent patients from ever becoming high-cost in the first place. The purpose of this study is to examine the impacts of an early and sustained intervention pathway, in comparison to the current standard of care, for the treatment of pain in opioid tolerant patients. It is hypothesized that patients randomized to the intervention pathway, in comparison to the control, will lead to decreased costs of care, a reduction in opioid usage within 3 and 6 months, and decrease in hospital readmission rates.
Interventions
OTHERNew Clinical Pathway
Sponsors
Massachusetts Institute of Technology
University of California, Irvine
Duke University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients (18 years and older) * Known opioid tolerant (as determined per FDA criteria) * Agree to sign the informed consent and HIPAA forms
Exclusion criteria
* Patients under the age of 18 years * No known opioid tolerance * Do not agree to sign the informed consent and HIPAA forms
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Returns to Acute Care | Discharge through 90 days post-discharge | Hospital Readmissions and Emergency Department Utilizations |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Opioid Tolerance Status | Admission through 12 months post-discharge | Opioid tolerance as inferred from opioid prescription and usage per FDA exposure threshold definition for opioid tolerance. |
| Pain at Discharge | Measured upon day of discharge from index hospitalization; up to 18 months from the date of randomization | Patient-reported pain at the time of discharge from index hospitalization |
| Hospital Length of Stay | Measured upon day of discharge from index hospitalization; up to 18 months from the date of randomization | Duration of index inpatient hospitalization. |
| Opioid Analgesic Use | Discharge through 90 days post-discharge | Quantification of opioid analgesic use over time |
| Returns to Acute Care | Discharge through 12 months post-discharge | Hospital Readmissions and Emergency Department Utilizations at an extended time horizon |
| Healthcare Expenditures | Admission through 12 months post-discharge | Inpatient and outpatients costs |
| Use of Rescue Drugs | Admission through 12 months post-discharge | Antagonist usages for the reversal of index drug effects (opioid and benzodiazepine) |
| Latency to Hospital Readmission | Discharge through 12 months post-discharge | Time between discharge from index hospitalization to readmission |
Countries
United States
Outcome results
None listed