Building Better Interdisciplinary Pain Teams Across Disciplines

建立更好的跨学科跨学科疼痛团队

• 批准号: 10316464
• 负责人: Karleen Frances Giannitrapani
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10316464
• 关键词: Address; Affect; Award; Behavior; Caring; Clinical; Cluster randomized trial; Collaborations; Complex; Dimensions; Discipline; Education; Elements; Emotional; Empirical Research; Ensure; Epidemic; Evaluation; Exhibits; Future; Goals; Intervention; Interview; Leadership; Learning; Literature; Logic; Mediation; Medicine; Mentors; Mentorship; Methodology; Methods; Modeling; Opioid; Pain; Pain management; Patient Care; Patients; Perception; Pharmacists; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Primary Health Care; Process; Production; Provider; Randomized; Randomized Controlled Trials; Reaction Time; Research; Resources; Role; Scientist; Site; Specialist; Structure; Team Process; Techniques; Testing; Thinking; Time; Training; Twin Multiple Birth; Veterans; Work; academic preparation; acceptability and feasibility; arm; base; career; career networking; chronic pain; chronic pain management; clinical care; design; experience; implementation science; improved; innovation; insight; interdisciplinary approach; intervention mapping; novel; novel strategies; opioid tapering; opioid use; pilot test; primary care setting; programs; randomized controlled design; randomized controlled study; randomized trial; recruit; scaffold; skills; social; systematic review; theories; therapy design; therapy development; treatment arm; treatment as usual; trial design; user centered design

Background: Chronic pain disproportionately affects Veterans and is often managed in VA primary care. Because chronic pain may exhibit physical, emotional, social, and existential dimensions, individualized, interdisciplinary approaches are clinically important. Various pain team models have been implemented in diverse clinical settings, and some are effective. However, to meet the complex needs of specific patients, pain teams often benefit from dynamic membership and different providers (e.g., pharmacist) fulfilling specific roles or tasks (e.g., opioid tapering). The providers who come together around one patient may or may not work together regularly or in the same combinations on other patients. In fact, dynamic teams and bounded teams often overlap. Compared with bounded teams, dynamic teaming, which I refer to hereafter as “teaming”, is a more complex process with a smaller empiric research base. Whether teams are bounded or dynamic (and often they have elements of both), they need to coordinate/negotiate and understand their mutual roles and role boundaries to serve patients effectively. Facilitating “teaming”, through establishing scaffolds, represents a strategy for organizing providers with dynamic membership around shared patient care goals. Significance/Impact: Developing a “teaming” intervention to facilitate collaboration around the numerous tasks involved in providing good and safe pain management is particularly timely as it aligns with the VA ORD clinical priorities. This work will be done in partnership with Veterans, providers, and operational leaders from the national pain program office to ensure alignment with VA pain and opioid initiatives. Innovation: The proposed intervention will create team scaffolds and a teaming facilitation process for interdisciplinary providers that participate in pain care tasks. The integration of organizational theory and co- design principals and strategies to produce and test a teaming intervention represents a novel approach for improving processes of pain care in the VA. Specific Aims: This proposal seeks to address scientific gaps through three projects. AIM1: Identify roles, structures and processes of interdisciplinary providers involved in primary care based chronic pain management. AIM2: Co-design an intervention to improve interdisciplinary “teaming” with VA providers and Veterans. AIM3: Pilot test the feasibility and acceptability of a teaming intervention for improved pain management at one site. Methodology: To yield insights on teams, teamwork and teaming and AIM3 study features for trial design, AIM1a will complete a systematic review of randomized controlled trials of chronic pain care in primary care settings. To characterize the concept of dynamic teaming and garner insights on teaming for chronic pain in PACTs, 1b will use semi-structured interviews to explore experiences and perceptions of PACT providers, pharmacists, pain specialists, non-pharmacologic providers, and supervisors/leadership (n=45). Building on AIM1 insights and principles and processes of co-design, I will build a logic model 1) of the problem and 2) for the desired change. I will conduct 3) theory-based design and 4) intervention production with providers and Veterans, followed by 5) implementation planning with the practical, robust implementation and sustainability Model (PRISM), and 6) evaluation planning. Patients (n=30) and interdisciplinary PACT teams (n=10) involved in “teaming” around chronic pain management at the VA Palo Alto will be recruited for the pilot of an intervention arm to inform feasibility and acceptably of a subsequent randomized trial. Following this pilot work, I will apply for an HSR&D IIR to conduct a two-arm cluster randomized trial (usual pain processes vs. “teaming” intervention). Implementation/Next Steps: Through the successful execution of this work, we will be prepared to submit a VA HSR&D merit award application for a fully powered trial of the “teaming” intervention in comparison to usual care. The co-design process and resultant teaming intervention will serve as a model to develop strategies to support clinicians teaming in a diverse array of VA settings.

背景：慢性疼痛对退伍军人的影响尤为严重，通常在退伍军人管理局初级保健中进行治疗。 因为慢性疼痛可能表现出身体、情感、社会和存在维度，个体化、 跨学科方法在临床上很重要。各种疼痛团队模型已在 不同的临床环境，有些是有效的。然而，为了满足特定患者的复杂需求，疼痛 团队通常受益于动态的成员资格和履行特定角色的不同提供者（例如药剂师） 或任务（例如阿片类药物逐渐减少）。聚集在一名患者周围的提供者可能会也可能不会工作 定期一起使用或以相同的组合对其他患者进行治疗。事实上，动态团队和有界团队 经常重叠。与有界团队相比，动态团队（以下简称“团队”）是一种 更复杂的过程和更小的经验研究基础。团队是有界的还是动态的（以及 通常他们两者都有），他们需要协调/谈判并了解他们相互的角色和 有效服务患者的角色边界。通过建立脚手架促进“团队合作”，代表了 围绕共同的患者护理目标组织具有动态成员资格的提供者的策略。 意义/影响：制定“团队”干预措施以促进围绕众多任务的协作 参与提供良好和安全的疼痛管理是特别及时的，因为它与 VA ORD 临床一致 优先事项。这项工作将与退伍军人、提供商和运营领导者合作完成 国家疼痛计划办公室确保与 VA 疼痛和阿片类药物倡议保持一致。 创新：拟议的干预措施将创建团队支架和团队促进流程 参与疼痛护理任务的跨学科提供者。组织理论与合作的整合 设计原则和策略来产生和测试团队干预代表了一种新颖的方法 改善退伍军人管理局的疼痛护理流程。 具体目标：该提案旨在通过三个项目弥补科学差距。 AIM1：确定角色， 参与基于初级保健的慢性疼痛管理的跨学科提供者的结构和流程。 AIM2：共同设计一项干预措施，以改善与 VA 提供者和退伍军人的跨学科“团队合作”。目标3： 试点测试团队干预的可行性和可接受性，以改善某一地点的疼痛管理。 方法：为了深入了解团队、团队合作和团队合作以及试验设计的 AIM3 研究特征，AIM1a 将完成对初级保健机构中慢性疼痛护理的随机对照试验的系统评价。 为了描述动态团队的概念并获得有关 PACT 中慢性疼痛团队的见解，1b 将使用半结构化访谈来探索 PACT 提供者、药剂师、疼痛的经验和看法 专家、非药物提供者和主管/领导 (n=45)。基于 AIM1 见解和 协同设计的原则和流程，我将构建一个逻辑模型 1) 问题和 2) 所需的更改。 我将与提供者和退伍军人一起进行 3) 基于理论的设计和 4) 干预生产，然后是 5) 使用实用、稳健的实施和可持续性模型 (PRISM) 进行实施规划，以及 6) 评估规划。参与“团队合作”的患者 (n=30) 和跨学科 PACT 团队 (n=10) 帕洛阿尔托退伍军人管理局的慢性疼痛管理人员将被招募为干预部门的试点，以告知 随后随机试验的可行性和可接受性。在此试点工作之后，我将申请 HSR&D IIR 进行一项双臂整群随机试验（普通疼痛过程与“团队”干预）。 实施/后续步骤：通过成功执行这项工作，我们将准备提交 VA HSR&D 优异奖申请，用于与常规护理相比的“团队”干预的全面试验。 共同设计过程和由此产生的团队干预将作为制定支持战略的模型 临床医生在各种 VA 环境中进行合作。