title: A standardized quality assessment system to evaluate pain detection and management in the nursing home.
abstract: BACKGROUND
  Assessment and management of pain for nursing home residents is frequently reported to be inadequate, yet few studies have used objective criteria to measure the quality of care related to pain.
  
  
  OBJECTIVE
  Field test a standardized resident interview and medical record review protocol to assess and score quality indicators relevant to pain.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  Thirty nursing homes (NHs).
  
  
  METHODS
  Seven hundred ninety-four residents met overall eligibility criteria. Quality indicators were scored for those residents who met specific eligibility requirements for each pain indicator.
  
  
  METHODS
  Medical record reviews were completed for 542 participants, and data were used to score 12 indicators related to pain assessment, management, and response to treatment. A seven-item pain interview was attempted with all 794 participants and completed with 478 participants who were rated by NH staff as cognitively aware.
  
  
  RESULTS
  Quality indicators could be reliably scored. Physicians scored low on assessment of pain, performing targeted history and physical examinations, documenting risk factors for use of analgesics, and documenting response to treatment. Forty-eight percent of participants (227/478) reported symptoms of chronic pain during the interview, and 81% of this group reported a preference for a pain medication. However, nearly half had no physician assessment of pain in the past year and only 42% were receiving pain medication. Licensed nurse assessments of pain were documented weekly; but, more than 50% of those reporting symptoms of chronic pain on interview had nurse pain scores of 0 for 4 consecutive weeks prior to interview.
  
  
  CONCLUSIONS
  Infrequent or incomplete physician pain assessment and treatment and inaccurate documentation by licensed nurses limits evaluation of pain care quality based on medical record review alone. A brief resident interview identified participants reporting symptoms of chronic pain not documented in the medical record and those with a preference for medication. Initial targeting of residents with self-reported pain maximizes the efficiency of the standardized scoring system described in this study. Focusing on explicit process measures clearly identifies areas for improvement and represents an important step in assessing the quality of pain care in the NH.
authors.affiliation: Los Angeles Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Los Angeles, CA 90095, USA. mcadogan@ucla.edu
authors.forename: Mary P
authors.initials: MP
authors.lastname: Cadogan
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.forename: Nahla R
authors.initials: NR
authors.lastname: Al-Sammarrai
authors.forename: Noriko
authors.initials: N
authors.lastname: Yamamoto-Mitani
authors.forename: Georgina
authors.initials: G
authors.lastname: Cabrera
authors.forename: Dan
authors.initials: D
authors.lastname: Osterweil
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D002140:California; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004282:Documentation; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008485:Medical Audit / Q000379:methods*; D009735:Nursing Homes / Q000592:standards*; D010003:Osteoarthritis / Q000175:diagnosis / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D019984:Quality Indicators, Health Care
chemical_list: D000700:Analgesics