Dissemination and Implementation of Patient-centered Indicators of Pain Care Quality and Outcomes

Susan L. Beck, Nancy Dunton, Patricia H. Berry, Jeannine M. Brant, Jia Wen Guo, Catima Potter, Beth Spornitz, Jacqueline Eaton, Bob Wong

    Research output: Contribution to journalArticlepeer-review

    11 Scopus citations


    Background: Previous approaches to measuring and improving nursing-sensitive, patient-centered metrics of pain quality and outcomes in hospitalized patients have been limited. Methods: In this translational research study, we disseminated and implemented pain quality indicators in 1611 medical and/or surgical, step-down, rehabilitation, critical access, and obstetrical (postpartum) units from 326 US hospitals participating in the National Database of Nursing Quality Indicators. Eligible patients were English-speaking adults in pain. Trained nurses collected patients' perceptions via structured interview including 9 pain quality indicators, demographic, and clinical variables; these patient experience data were merged with unit and hospital level data. Analyses included geographic mapping; summary statistics and 3-level mixed effects modeling. Results: Hospitals in 45 states and District of Columbia participated. Of 22,293 screened patients, 15,012 were eligible; 82% verbally consented and participated. Pain prevalence was 72%. Participants were 59.4% female; ages ranged from 19 to 90+ (median: 59 y); 27.3% were nonwhite and 6.5% were Hispanic. Pain intensity on average over the past 24 hours was 6.03 (SD=2.45) on a 0-10 scale. 28.5% of patients were in severe pain frequently or constantly. Race (nonwhite), younger age, being female and nonsurgical were associated (P<0.001) with greater pain. Care quality indicators ranking lowest related to discussion of analgesic side effects and use of nonpharmacologic approaches. Conclusions: Unrelieved pain remains a high-volume problem. Individual factors and unit type were significantly associated with pain outcomes. Hospitals can employ these quality indicators to direct continuous quality improvement targeting pain care quality.

    Original languageEnglish (US)
    Pages (from-to)159-166
    Number of pages8
    JournalMedical care
    Issue number2
    StatePublished - Feb 1 2019


    • dissemination and implementation
    • hospitals
    • nursing
    • pain
    • patient experience
    • quality indicators

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health


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