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Grants and Funded Projects
Evidence-Based Practice: Acute Pain Management in the Elderly
Methods
An experimental design will be used to test the effectiveness of a multifaceted, interdisciplinary intervention to translate into practice an evidence-based guideline on "Acute Pain Management in the Elderly". The study is being carried out over three years. Year 01 focuses on collection of baseline data, formulating an evidence-based guideline on "Acute Pain Management in the Elderly", and refinement of a staff education program. Year 02 focuses on implementation of the evidence-based practice guideline on "Acute Pain Management in the Elderly" at the experimental sites. Year 03 evaluates the sustainability of practice changes that are hypothesized to occur in the experimental sites.
Data Sources
Two types of data will be collected during the course of the study.
- Data abstracted from the medical records of patients 65 years or older who are admitted to a study unit at a participating site with a diagnosis of hip fracture (ICD-9 category 820)
- Questionnaire data from nurses and physicians regarding their knowledge and attitudes toward guidelines, innovations, and pain management and questionnaire data from hospital administrators regarding characteristics of the hospital and the patient care unit.
Experimental Intervention
In participating hospitals that are randomized to the experimental group, the following techniques will be used during Year 02 to promote adoption of the evidence-based guideline:
- Localization of the guideline
- Promotion of the guideline by nurse and physician opinion leaders
- Education of nurses and physicians
- Outreach by an advanced practice nurse
- Performance gap assessment
- Focus groups
- Trialing the evidence-based guideline
Dependent Variables
The major dependent variables are 1) rate and extent of adoption by nurses and physicians of the evidence-based guideline on "Acute Pain Management in the Elderly"; 2) nurses' and physicians' perceived barriers to use of evidence-based guidelines in practice; and 3) the cost of delivering an intervention that promotes adoption of the evidence-based guideline.
Rate of Adoption . Rate of adoption is defined as the pattern of change over time in adherence of nurses and physicians to the evidence-based practice guideline on "Acute Pain Management in the Elderly". Adherence to the guideline will be measured by critical indicators of nurse and physician behaviors that are abstracted retrospectively from medical records of patients 65 years of age or older who are admitted for hip fracture to the study unit(s).
Extent of Adoption . Extent of adoption is defined as 1) nurses and physicians self-reported stage of adoption of specific pain assessment and treatment practices and 2) the degree of adherence by nurses and physicians to the evidence-based guideline on "Acute Pain Management in the Elderly".
Barriers . Barriers to use of evidence-based guidelines will be measured by means of questionnaires to nurses and physicians. Barriers and facilitators of guideline use will also be assessed using a focus group approach following the implementation phase.
Intervention Cost-Effectiveness Ratios . Information will be collected on both adoption outcomes and costs that will be sufficient to estimate cost-effectiveness ratios. A cost-effectiveness ratio contrasts the difference in costs associated with alternative interventions relative to differences in individual outcomes. For a comparison of an intervention with an alternative, the following cost effectiveness ratio is computed:
