947: Using electronic medical record data to quantify racial and ethnic differences in pain management following cesarean birth

Abstract

Racial disparities in pain management have been documented in health care settings. We sought to evaluate associations between patient race and ethnicity and pain management following cesarean birth. We conducted a retrospective cohort study of mothers following cesarean birth at North Carolina Women's Hospital between 7/1/2014 and 6/30/2016. Maternal pain scores (0-10) and medication administration were documented in Epic Electronic Medical Record (EMR) as part of routine clinical care. We used these data to determine frequency of pain assessment, pain scores, and administration of opiate analgesia from 0 to 48 hours postpartum (PP). Opiates administered were converted to 5 mg oxycodone tablet equivalents (OTE). We excluded from our sample women who received general anesthesia, were in the intensive care unit after delivery, were currently treated with methadone or buprenorphine, or received ≥2 opiate prescriptions during antenatal care. We used chi square tests to compare prevalence of severe pain, indexed by pain scores > 7, and linear regression models to compare OTE administered by maternal race/ethnicity, adjusting for insurance status, primary language, age, and primiparity. P values <0.05 were considered statistically significant. 1,970 women underwent cesarean section during the study period, of whom 1,776 met inclusion criteria. EMR records included 32,361 pain assessments and 13,989 opiate doses administered from 0-48 hours after c-section. The number of pain assessments differed by race-ethnicity, with the highest number of assessments for non-Hispanic white women (Table, p<.001). Mean pain scores were highest for non-Hispanic black women (Figure), and these women were most likely to have at least one pain assessment >7/10, whereas Asian women were the least likely (chi square p < .001). Although non-Hispanic black women reported higher pain scores, they received less opiate analgesia than non-Hispanic white women (OTE mean, [se] 0-24h PP: 7.0 [0.3] vs. 8.1 [0.3]; 24-48h PP: 7.8 [0.5] vs 8.7 [0.5], p<.001), as did Asian, Hispanic and other women, adjusting for insurance, language, age, and primiparity. We found racial differences in pain scores and administration of opiates. EMR data can be leveraged to identify differences in care delivery that may contribute to health disparities.View Large Image Figure ViewerDownload Hi-res image Download (PPT)