Objectives: To identify the impact of clinical risk adjustment models for evaluating pain medication consumption differences between private rooms and a multibed ward. Background: Views of nature
are reported to reduce anxiety and pain for patients. This often leads to prioritizing large windows with views for patient rooms; however, it is not clear how other factors influencing pain (e.g., patient
demographics) may confound evaluations of room design.
Methods: We identified 1,284 patients at the University of Michigan undergoing thyroidectomy where patients recovered in one of the two locations: a private room with a view to nature or a multibed ward with no windows. We used pain medication data from the electronic medical record and risk adjustment models to evaluate pain medication consumption between the room types.
Results: Private room patients did not use more pain medications when measured using unadjusted morphine milligram equivalents (18.3 vs. 15.3 mg, p ¼ .06). Risk adjusting for age, gender, comorbidities, opioid history, and procedure subtype resulted in private room patients demonstrating higher consumption of morphine milliequivalents (17.5 vs. 15.5 mg, p < .01). In contrast, risk adjusting for age, gender, opioid history, and selected comorbidities estimated higher pain medication consumption for multibed ward patients relative to private rooms (16.27 vs. 15.51 mg, p < .05).
Conclusion: Estimated differences of pain medication consumption for patients in differently designed rooms varied depending on the risk adjustment model. These findings underscore the importance of understanding appropriate clinical measurement and risk adjustment strategies to accurately estimate the impact of design, before applying research into practice.
Experts
Andrew M. Ibrahim MD, MSc is the Maud T. Lane Research Professor of Surgery, Architecture & Urban Planning and Vice Chair for Health Services Research in the Department of Surgery at the University of Michigan. He also serves Chief Medical Officer and Senior Principal at the global design and architecture firm, HOK. He completed his undergraduate and medical degrees both with Honors at Case Western Reserve University with a year of coursework at University College London and The Bartlett School of Architecture. His research at the interface of healthcare delivery, surgery and architecture is supported by >$10million of extramural funding including R01s from AHRQ and the NIH. In 2023, he was appointed to the Board of Directors at Academy Health and the Board of the Center for Health Design. More about his work can be found here: www.SurgeryRedesign.com.