Can just-in-time, evidence-based "reminders" improve pain management among home health care nurses and their patients?

• HIT Description: Decision support More info...
  
• Purpose of Study: To assess the impact and cost-effectiveness of two nurse-targetd email-based interventions to improve nurse pain management and outcomes in cancer patients
  
• Years of study: Not Available
  
• Study Design: Randomized controlled trial
  
• Outcomes: Impact on health care effectiveness and quality, Impact on efficiency, utilization and costs
  

• Settings: Home health care agency in NYC
• Intervention: Nurses were randomly assigned to usual care or one of the two intervention groups. An email to the nurse highlighted six pain specific recommendations. Nurses in the augmented intervention group received additional email prompts, patient education materials and follow-up outreach by a clinical nurse specialist.
• Evaluation Method: Nurses in both intervention groups received an email highlighting 6 pain-specific recommendaters. Utilization data for developing cost estimates was obtained through administrative data and patient self-report on medical care use.
• Description: Chart abstraction, patient interviews, administrative data and patient self report for utilization data; email message.
• Strategy: An expert panel, informed by the results of a literature review and side-by-side comparison of pain management guidelines, identified the most important practices for the intervention
• Financial Context: Low income urban population
• Costs: The average cost associated with administrative and direct home care was $2,642 for the usual care group, $2,789 for the basic intervention, and $2,903 for the augmented intervention. The difference is not significant.
• Healthcare Utilization: The probability of a hospital stay was lower for the augmented intervention group than the usual care group (p=.08). Use of complementary therapies (massage, relaxation/imagery) was significantly lower among the augmented group.
• Quality of Care and Patient Safety Outcome: On a scale of 1 to 10, patients in the usual care, basic, and augmented intervention groups had mean scores for pain Òat its worstÓ of 4.5, 3.6, and 3.4, respectively (p.05 for the augmented group compared to usual care). There were no significant differences in nurses' measuring and tracking of pain.