PAIN-OUT

Improvement in Postoperative PAIN OUTcome

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 Obiettivo del progetto (Objective)

'The main objective of the proposed project is to develop and to validate a system for measurement and feedback of outcome quality and support of decision making. The project will be executed in the areas of postoperative pain management which serves as an example for other fields of medicine with a high variation of care. The project will provide the medical community with a unique, user-friendly system to improve treatment of patients with postoperative pain. We propose to develop and implement a web-based information system, featuring three functions: Feedback and benchmarking system which provides participating sites with continuously updating data and analyses about the quality of care they provide compared to other institutions and allows identification of ‘best clinical practice’. Clinical Decision Support System for Post-Operative Pain, which responds to queries made by physicians for advice regarding treatment of individual patients. A Knowledge Library which provides clinicians with easily accessible summaries of evidence-based recommendations tailored to specific post-operative situations. The first two functions will draw their information from a large database or registry. The registry will receive data about post-operative patients from x participating clinical sites across Europe. The third function, the Knowledge Library, will draw its information from published, peer-reviewed studies, and will be updated periodically. To increase the benefit of the system to end-users, the registry will be complemented with patient data on side effects and treatment costs. All of these will be integrated into the feedback system. The proposed project is the first comprehensive, concerted European effort in the field of improving clinical decision making. It integrates experience gained from national initiatives, and the expertise of world-leading, European-based, groups dealing with benchmarking, health outcomes and health care utilization research'

Introduzione (Teaser)

Too many people needlessly suffer prolonged pain following surgery. A new system collects data from hospitals, giving medical staff feedback and suggesting the best course of action.

Descrizione progetto (Article)

About 40 % of surgical patients suffer from moderate to severe post-operative pain, despite receiving treatment for it and despite the availability of comprehensive pain management guidelines. Such pain causes avoidable suffering, resulting in longer hospital stays and higher health care costs.

Thus, the EU funded the http://ec.europa.eu/research/health/public-health/clinical-outcome-into-practice/projects/pain-out_en.html ('Improvement in postoperative pain outcome') (PAIN OUT) project to study the problem. This project began in January 2009, with four-year funding, and as of 2013 will continue without EU funding. The project's main objective was to develop and validate a system for measuring outcome quality in terms of post-surgical pain. This took form as a pain registry, a large database incorporating and updating clinical data and subjective patient reports mostly from participating hospitals. As of 2012, it contained 35 000 records, making it one of the world's largest. The registry has two main purposes, first being quality improvement in the form of feedback (compared against other hospitals). Its second function is to facilitate health care research.

Much of the project's work involved the technical establishment and population of the database. This included creation, validation and translation of a questionnaire supplied to hospitals, plus other modules of the registry such as the decision support system and electronic knowledge library: guidelines summarising current therapy recommendations. Major outcomes were the scientific results, covering three main areas. A health economics analysis indicated that a proportion of patients still suffer post-operative pain at the seven-day point, strongly affecting quality of life measures. A costing analysis of this data is underway. Other studies included a patient satisfaction survey. This survey revealed considerable variation in factors such as numbers of hospital visits and time committed by pain-team members causing variation in service among hospitals. Gender/age analysis revealed that some patients, especially older women, need extra attention for pain management.

Rapid dissemination gained the project strong support, whereby it expanded to include 60 hospitals on 5 continents. The project's results were disseminated at 70 international meetings and 9 scientific publications to date.

PAIN OUT's legacy will be improved pain management for patients, and savings for health care systems.