Examining Equitable Pain Reassessment Practices: A Pre-Post Intervention Study.

Abstract

Purpose: This study assessed the effectiveness of two separate interventions in addressing adherence to pain reassessment protocols. The first intervention was a real-time, patient-specific electronic health record alert, and the second involved the development and implementation of an asynchronous cumulative report used to follow up with staff.

Design: Pre-post interventional.

Methods: We evaluated changes in pain reassessment adherence following the implementation of both interventions in emergency and non-emergency departments in December 2023. Pain medication administration data were extracted from the electronic health record for patients treated at an Indianapolis-based hospital system between January 1, 2023, and January 31, 2025. Outcomes included overall adherence rates and percentage point differences by race/ethnicity, age, sex, and preferred language.

Results: Our analytic sample included 521,381 pain medication administrations, representing 70,059 unique patients. In December 2023, the overall pain reassessment adherence rate was 62% across all departments. A year later in early 2025, the adherence rate had increased nearly 10 percentage points. Adherence rates by racial/ethnic group in December 2023 were 60%, 54%, 60%, and 69% for Black/African American, Hispanic, other, and non-Hispanic White, respectively. By January 2025, adherence rates were 65%, 55%, 51%, and 72%, respectively; however, the percentage point difference between adherence rates by racial/ethnic group (compared with non-Hispanic Whites) increased among Hispanics and patients who identified their race/ethnicity as other.

Conclusions: Our study demonstrated that although implementing electronic alert and report-based interventions may have improved pain reassessment adherence across all settings in a safety-net hospital, these interventions did not improve existing disparities.

Clinical implications: Findings suggest that electronic interventions should be intentionally designed with an equity focus to ensure that gains in care quality are realized across all patient populations and do not inadvertently widen existing racial and ethnic disparities.