| Persons dying from terminal and chronic illnesses can, and should, experience a "good death." However, most Americans do not die this way, and many die in pain. Pain management is an end-of-life care priority because it is desired universally yet remains notably underapplied in many health care settings despite advancements in the field, including clinical best practice guidelines. The literature suggests that the varied and inadequate treatment of pain may stem more from the lack of public policies---or policies that are outdated and scientifically flawed---and less from problematic clinical and organizational policies. Primary authority for public pain policies lies with the states, specifically with state medical boards.;The purpose of this study was to examine the determinants of medical board pain policies, which establish the parameters for the organizational and clinical policies that ultimately drive patient care. First, four reliable and valid measures of medical board pain policy making were constructed. Second, explanatory models including economic, external demands, political systems, and institutional characteristic variables most likely to influence medical board pain policy decisions were constructed. Finally, event history analysis was used to examine the relationships between the medical board pain policies and these predictor variables over a 15-year period.;This analysis found that medical boards with more legal counselors had higher rates for adopting the four pain policies considered in this dissertation. Boards that previously had adopted more pain management policies than other boards consistently had a lower hazard rate for adopting these policies. Higher state general revenues, more conservative state government ideology, the previous adoption of an Intractable Pain Treatment Act, and having more neighbors with pain policies increased a medical board's hazard rate for adopting a pain policy while having more frequent annual medical board meetings decreased the hazard rate.;These results contribute to fields of comparative state policy and health services and policy research, and also make available valuable information for advocates and policy makers working to improve pain management-enhancing policies across the states. This dissertation provides a foundation for future research to assess how improved public policies can positively impact patient outcomes. |
