Evaluating the National Implementation of Virtual Interdisciplinary Pain Care Teams - TelePain

项目：慢性疼痛是残疾的主要原因，也是阿片类药物流行的主要原因， 自杀为退伍军人提供循证疼痛护理至关重要，但近三分之一的VA设施缺乏 跨学科，多模式疼痛管理计划。跨学科、多模式疼痛治疗（IMPT） 已被公认为高影响慢性疼痛的护理标准;然而，在VA之外，社区 疼痛诊所主要提供单一模式的治疗，重点是高报销医疗程序，而不是 IMPT。疼痛管理是VA成本最高的社区护理支出之一，但缺乏VA设施 IMPT团队严重依赖社区护理来进行疼痛管理。为了解决缺乏疼痛专家的问题， 较小的VA设施和社区疼痛护理的差距，国家疼痛管理和阿片类药物安全 计划（PMOP）正在推出一个远程医疗模型的虚拟专业疼痛团队，远程疼痛，提供证据- 向资源不足的区域提供基础设施综合方案培训。我们的运营合作伙伴正在VISN 20的成功基础上扩大规模 TelePain在全国范围内，从2021年6月开始每年3个VISN。PMOP需要严格的评估支持 评估这一高优先级TelePain计划的影响。鉴于其国家范围和范围， 实施设置，TelePain的推出提供了一个独特的机会来评估实施 该计划在弗吉尼亚州，与产生可操作的结果，不仅告知目前的努力， 未来的实施工作也将在弗吉尼亚州推广类似的项目。建议的目的 Partnered Evaluation Initiative是使用系统化的评估方法来持续改进TelePain 在9家VA机构实施并监测TelePain对患者结局和成本的影响。 项目目标：为了评估TelePain倡议的影响，本项目的具体目标包括：1. 评估TelePain实施的可接受性、可行性、采用、保真度、覆盖范围和成本， 新VISN，2.）前瞻性评价患者报告的临床结局，比较TelePain与转诊 社区护理或无专业疼痛护理（常规护理对照组），以确保TelePain受益 相对于普通护理的退伍军人，3。为了比较低价值疼痛护理的使用（例如，注射，不必要 影像学、脊柱融合手术）。 项目方法：所提出的活动将作为质量改进进行。我们将进行一次混合 方法，准实验性多地点评价，以检查实施成果和成本（目标1）， 临床结局，包括患者报告的结局和管理数据（目标2），以及经济 TelePain的影响（目标3）。本项目的数据来源包括行政和电子健康记录 数据来自弗吉尼亚州的企业数据仓库（CDW），药房福利管理服务，自杀 预防应用网络，国家死亡指数，管理成本会计办公室，费用 程序完整性工具中的基础文件，通过Qualtrics进行电子或纸质管理的患者调查- 通过邮寄和半结构化的采访病人和供应商。的新颖方面 一项建议是前瞻性队列患者调查（目标2）。为此，我们将确定潜在的合格患者 在三个比较组中（TelePain，与TelePain 1：1匹配，但涉及社区疼痛护理， 与TelePain 1：1匹配，但不转诊到专业疼痛护理），并将他们纳入6- 每月纵向调查3个时间点。前瞻性的多站点设计将提供严格的 使用对我们的运营合作伙伴至关重要的以患者为中心的结果对TelePain进行评估。 项目影响：本次评估的结果将为我们的业务合作伙伴提供信息， 国家实施TelePain。我们的研究结果将提供有关临床结果的证据， TelePain及其对疼痛护理成本的影响，这两者都是支持长期业务案例所必需的， 长期维持TelePain。

Project: Chronic pain is a leading cause of disability and a major contributor to the opioid epidemic and suicide. Providing evidence-based pain care to Veterans is vital, yet nearly 1 in 3 VA facilities lacks an interdisciplinary, multimodal pain management program. Interdisciplinary, multimodal pain treatment (IMPT) has been recognized as the standard of care for high-impact chronic pain; however, outside of VA, community pain clinics primarily offer unimodal treatment focused on high-reimbursement medical procedures instead of IMPT. Pain management is one of VA’s highest-cost community care expenditures, yet VA facilities that lack an IMPT team rely heavily on community care for pain management. To address the lack of pain specialists at smaller VA facilities and the gaps in community pain care, the National Pain Management and Opioid Safety Program (PMOP) is rolling out a telehealth model of virtual specialty pain teams, TelePain, to deliver evidence- based IMPT to under-resourced regions. Our operational partners are building on VISN 20’s success to scale up TelePain nationwide, starting with 3 VISNs per year in June 2021. PMOP needs rigorous evaluation support to assess the impact of this high-priority TelePain initiative. Given its national scope and range of implementation settings, the rollout of TelePain presents a unique opportunity to evaluate the implementation of this program in the VA, with the goal of yielding actionable findings to inform not only the current effort but also future implementation efforts to spread similar programs across the VA. The purpose of the proposed Partnered Evaluation Initiative is to use systematic evaluation methods to continually improve TelePain implementation and monitor the impact of TelePain on patient outcomes and costs at 9 VA facilities. Project objectives: To assess the impact of the TelePain initiative, the Specific aims of this project include: 1.) To assess the acceptability, feasibility, adoption, fidelity, reach, and costs of TelePain implementation at each new VISN, 2.) To prospectively evaluate patient-reported clinical outcomes, comparing TelePain to referral to community care or no specialty pain care (usual care control groups), to ensure that TelePain is benefitting Veterans relative to usual care, 3.) To compare use of low-value pain care (e.g., injections, unnecessary imaging, spinal fusion surgery) among patients referred to TelePain relative to control groups. Project Methods: The proposed activities will be conducted as quality improvement. We will conduct a mixed methods, quasi-experimental multisite evaluation to examine implementation outcomes and costs (Aim 1), clinical outcomes, including both patient-reported outcomes and administrative data (Aim 2), and economic impact of TelePain (Aim 3). Data sources for this project include administrative and electronic health record data from VA’s Corporate Data Warehouse (CDW), Pharmacy Benefits Management Services, the Suicide Prevention Applications Network, the National Death Index, the Managerial Cost Accounting Office, the Fee Basis files in the Program Integrity Tool, patient surveys administered electronically via Qualtrics or paper- based via postal mail, and semi-structured interviews with patients and providers. A novel aspect of the proposal is the prospective cohort patient survey (Aim 2). For this, we will identify potentially eligible patients across three comparison groups (TelePain, matched 1:1 to TelePain but referred to community pain care, matched 1:1 to TelePain but without referral to specialty pain care) on a weekly basis and enroll them in a 6- month longitudinal survey with 3 times points. The prospective, multisite design will provide a rigorous evaluation of TelePain using patient-centered outcomes that are of key importance to our operations partners. Project Impact: The results from this evaluation will inform and enhance our operational partners’ ongoing national implementation of TelePain. Our findings will provide evidence regarding the clinical outcomes of TelePain and its impact on pain care costs, both of which are needed to support a business case for the long- term sustainment of TelePain.