title: Does e-pain plan improve management of sickle cell disease associated vaso-occlusive pain crisis? a mixed methods evaluation.
abstract: OBJECTIVE
  There is limited application and evaluation of health information systems in the management of vaso-occlusive pain crises in sickle cell disease (SCD) patients. This study evaluates the impact of digitization of paper-based individualized pain plans on process efficiency and care quality by examining both objective patient data and subjective clinician insights.
  
  
  METHODS
  Retrospective, before and after, mixed methods evaluation of digitization of paper documents in Children's Hospital of Pittsburgh of UPMC. Subjective perceptions are analyzed using surveys completed by 115 clinicians in emergency department (ED) and inpatient units (IP). Objective effects are evaluated using mixed models with data on 1089 ED visits collected via electronic chart review 28 months before and 22 months after the digitization.
  
  
  RESULTS
  Surveys indicate that all clinicians perceived the digitization to improve the efficiency and quality of pain management. Physicians overwhelmingly preferred using the digitized plans, but only 44% of the nurses had the same response. Analysis of patient records indicates that adjusted time from analgesic order to administration was significantly reduced from 35.50 to 26.77 min (p<.05). However, time to first dose and some of the objective quality measures (time from administration to relief, relief rate, admission rate, and ED re-visit rate) were not significantly affected.
  
  
  CONCLUSIONS
  The relatively simple intervention, high baseline performance, and limited accommodation of nurses' perspectives may account for the marginal improvements in process efficiency and quality outcomes. Additional efforts, particularly improved communication between physicians and nurses, are needed to further enhance quality of pain management.
  
  
  CONCLUSIONS
  This study highlights the important role of health information technology (HIT) on vaso-occlusive pain management for pediatric patients with sickle cell disease and the critical challenges in accommodating human factor considerations in implementing and evaluating HIT effects.
authors.affiliation: The H. John Heinz III College, Carnegie Mellon University, Pittsburgh, PA, USA. Electronic address: yichinl@andrew.cmu.edu.
authors.forename: Yi-Chin
authors.initials: YC
authors.lastname: Kato-Lin
authors.affiliation: Aflac Center for Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Krishnamurti
authors.affiliation: The H. John Heinz III College, Carnegie Mellon University, Pittsburgh, PA, USA.
authors.forename: Rema
authors.initials: R
authors.lastname: Padman
authors.affiliation: Department of Statistics, Carnegie Mellon University, Pittsburgh, PA, USA.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Seltman
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016247:Information Storage and Retrieval / Q000379:methods*; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D010414:Pennsylvania; D011159:Population Surveillance; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Health information technology; Individualized pain plans; Mixed methods evaluation; Perception surveys; Process assessment; Sickle cell disease