Scaling Interoperable Clinical Decision Support for Patient-Centered Chronic Pain Care

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PROJECT SUMMARY/ABSTRACT The U.S. continues to face public health crises related to both chronic pain and opioid overdoses. Thirty percent of Americans suffer from chronic noncancer pain at a cost of $600 billion annually. Most patients with chronic pain first turn to primary care clinicians, who must choose from myriad treatment options based on relative risks and benefits, patient history, symptoms, and goals. Recently, with attention to opioid-related risks, prescribing has declined. However, clinical experts have countered with concerns that some patients, for whom opioid-related benefits outweigh risks, are being inappropriately discontinued from opioids. Unfortunately, primary care clinicians lack usable tools to help them partner with their patients in choosing pain treatment options that best balance risks and benefits in the context of patient history, symptoms, and goals. Thus, primary care clinicians and patients would benefit from patient-centered clinical decision support (CDS) for this shared decision making process. The objective of this three-year proposal is to study the adaptation and implementation of an existing interoperable CDS tool for pain treatment shared decision making, with tailored implementation support, in new clinical settings in the OneFlorida Clinical Research Consortium. Our central hypothesis is that tailored implementation support will increase CDS adoption and shared decision making. We further hypothesize that increases in shared decision making will lead to improved patient outcomes, pain and physical function. The proposed study builds on our team’s nearly ten-year history of research to design, implement, and evaluate CDS for pain care. The study responds to AHRQ’s PA-20-074 and aligns with AHRQ’s interest in opioid-related research (NOT-HS-18-015), and use of Fast Healthcare Interoperability Resources (FHIR) (NOT-HS-19-020). The CDS implementation will be guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. The evaluation will be organized by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Our specific aims are: 1) Adapt and tailor Pain Manager, AHRQ’s interoperable CDS tool, for implementation in primary care clinics affiliated with the OneFlorida Clinical Research Consortium; 2) Evaluate the effect of tailored implementation support on Pain Manager’s adoption for pain treatment shared decision making; and 3) Establish the feasibility and obtain preliminary data in preparation for a multi-site pragmatic trial targeting the effectiveness of Pain Manager and tailored implementation support on shared decision making and patient-reported pain and physical function. The research will generate evidence on strategies for implementing interoperable CDS in new clinical settings across different types of electronic health records. The study will also inform tailored implementation strategies to be further tested in a subsequent hybrid effectiveness-implementation trial. Together, these efforts will lead to important new technology and evidence that patients, clinicians, and health systems can use to improve care for millions of Americans who suffer from pain and other chronic conditions.