Grant: Partnerships for Health System Improvement (PHSI)

Acute Pain; Elder-Centered Care; Elderly; Emergency Departments; Fractures; Healthcare Services; Implementation; Knowledge Transfer; Length Of Stay; Pain Management

<html> <body>The Quebec population is aging. The number of individuals aged &ge; 75 years who consult the Emergency Department has increased by 30% in the last decade and they now represent 25% of all stretcher-care visits. Skeletal fractures cause acute pain and are a frequent reason for ED visits in this population. Pain is vastly under-recognized and under-treated in older adults, particularly in those with cognitive impairment. Pain relief, evidently important for humanitarian reasons, improves patients&rsquo; wellbeing, facilitates return to mobility and reduces the risk of delirium. <br> We have recently demonstrated successful implementation of an interdisciplinary pain management program, <strong>PAINFREE</strong>, in adult EDs at McGill University Health Center and documented improvement in pain management indicators in older adults who consulted following a skeletal fracture. Having established the feasibility of implementing this program and its efficacy on patient-centered and -reported outcome measures (pain intensity, analgesia effectiveness, mobility) we now partner with the Ministry of Health and Montreal EDs to deploy PAINFREE on a larger scale. This collaborative project brings researchers, clinicians, managers, patient representatives and experts in pain management, geriatrics and health services together with high-level decision-makers from the Quebec Ministry of Health. Using a stepped-wedge cluster randomized trial design, we will implement PAINFREE sequentially in 6 EDs in the greater Montreal area where as each ED site acts as its own control and provides data in both pre- and post-implementation periods. Mixed methods analysis will be used to link quantitative (pain management indicators pre- and post-implementation) to qualitative (feasibility, fidelity and acceptability of implementation) data sets to facilitate data triangulation to evaluate the effects of PAINFREE in real world settings.<br> The <strong>primary objective</strong> is to improve acute pain management in adults &ge; 75 years who consult the ED following a fracture, by the implementation of the interprofessional best-care practice pain management program, PAINFREE, integrated with the Health Ministry mandated provincial elder-centered approach to clinical care. <strong>Secondary objectives</strong> are to reduce length of stay in ED, decrease return visits to the ED for pain, and to ensure active transfer of knowledge gained to the healthcare network. The <strong>project outputs</strong> will consist of: <strong>1)</strong> the creation of adaptable educational and point-of-care pain management tools for healthcare professionals and patients/families, <strong>2)</strong> the identification of predictors of successful intervention implementation in the ED milieu, and <strong>3)</strong> the facilitation of effective partnerships between ED staff and those responsible for the elder-care centered approach implementation locally and regionally. <br> Our project addresses the timely and highly relevant problematic of acute pain management in older adults to optimize their care while in the ED and facilitate their safe and rapid return to the community.</body> </html>

Inst of Hlth Serv &amp; Policy Res~ $220,001~ $0~Knowledge Translation Branch~ $179,999~ $0~