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：慢性疼痛不成比例地影响退伍军人，并且经常在VA初级保健中进行管理。 因为慢性疼痛可能存在身体，情感，社交和现有维度， 跨学科方法在临床上很重要。各种疼痛团队模型已在 潜水员的临床环境，有些是有效的。但是，为了满足特定患者的复杂需求，疼痛 团队通常会受益于动态会员资格和不同的提供商（例如药剂师）履行特定角色 或任务（例如，阿片类锥度）。一名患者围绕一个患者的提供者可能会或可能不起作用 定期或与其他患者的相同组合在一起。实际上，充满活力的团队和有限的团队 经常重叠。与有限的团队相比，我称之为“团队”的动态团队是一个 更复杂的过程，具有较小的经验研究基础。团队是有限的还是动态的（并且 他们通常都有两者的要素），他们需要协调/谈判并理解他们的相互角色和 有效地为患者服务的角色边界。通过建立脚手架来促进“团队”代表 围绕共享患者护理目标组织提供者的策略。 意义/影响：开发“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特别及时，因为它与VA ORD临床一致 优先事项。这项工作将与退伍军人，提供者和运营领导者合作完成 国家疼痛计划办公室，以确保与VA疼痛和阿片类药物倡议保持一致。 创新：拟议的干预将创建团队脚手架和组合设施的过程 参加疼痛护理任务的跨学科提供者。组织理论与共同的整合 设计和测试组合干预的校长和策略代表了一种新颖的方法 改善VA疼痛护理过程。 具体目的：该提案旨在通过三个项目解决科学差距。 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过程。 AIM2：共同设计一种干预措施，以改善与VA提供者和退伍军人的跨学科“团队”。 AIM3： 试点测试团队干预的可行性和可接受性，以改善一个站点的疼痛管理。 方法论：为试验设计的团队，团队合作和团队以及AIM3研究功能提供见解，AIM1A 将完成对初级保健环境中慢性疼痛护理的随机对照试验的系统评价。 为了表征动态团队的概念和Garner洞察力对族长慢性疼痛的团队的见解，1B 将使用半结构式访谈来探索公约提供者，药剂师，痛苦的经验和看法 专家，非药物提供者和主管/领导力（n = 45）。以AIM1见解为基础 共同设计的原理和过程，我将建立问题的逻辑模型1）和2）为所需的更改。 我将进行3）基于理论的设计和4）与提供者和退伍军人的干预生产，其次是5） 实施计划，具有实用，强大的实施和可持续性模型（PRISM），以及6） 评估计划。患者（n = 30）和跨学科协议团队（n = 10）参与了“团队” VA Palo Alto的慢性疼痛管理将被招募为干预部门的飞行员，以告知 可行性，并且可以接受随后的随机试验。遵循此试点工作，我将申请HSR＆D IIR进行两臂群集随机试验（通常的疼痛过程与“团队”干预）。 实施/下一步：通过成功执行这项工作，我们将准备提交VA 与常规护理相比，HSR＆D的绩效申请是对“团队”干预措施的全力试验申请。 共同设计的过程和由此产生的组合干预将成为制定支持策略的模型 临床医生在一系列VA环境中组合。