Administrative Supplement for: Improving Access to Chiropractic Care for Low Back Pain in Underserved Primary Care Settings: Development and Evaluation of a Multi-level Implementation Strategy

项目摘要 背景：腰痛（LBP）是常见的，致残和昂贵的。美国医师学会（American College of Physicians） 指南推荐非药物治疗（例如，脊柱按摩，加热，按摩， 针灸）作为LBP安全有效的一线治疗方法。然而，这些治疗大多数 通常提供给中高收入的主要是白色社区， 收入种族多样化的患者。脊椎按摩疗法，包括脊椎按摩，是一种典型的 这一护理差距的一个例子;很少有脊椎指压治疗医生（DC）被纳入医疗环境， 护理提供者很少提到社区区中心。目标和目的：Roseen博士的长期目标 职业目标是成为一名独立的调查员，研究 LBP治疗服务不足的人群。这个K23职业发展奖将使Roseen博士获得 在进行务实的临床试验，可以评估LBP的现实世界的有效性先进的技能 治疗，并成为有能力的发展和评估的实施战略。 职业发展活动：K23应用程序将提供结构化的教学和实践培训， Roseen博士在脊椎按摩和流行病学方面的培训，通过在以下方面的经验和教育， 过程映射，定性方法，实施策略，实用试验的结果测量， 先进的统计分析。该计划将使Roseen博士参与强有力的培训活动，包括 指导，课程，研究项目，出版和演示，讲习班和研讨会，赠款写作， 和负责任的研究行为。导师：Roseen博士的导师团队由 来自临床研究、卫生服务研究、流行病学、生物统计学、医学人类学、 实施科学和初级保健。环境：Roseen博士将受益于一个全面的 波士顿大学（BU）、波士顿医学中心、临床流行病学BU的研究培训项目 研究和培训单位，BU改进和实施科学中心，以及BU临床和 翻译科学研究所。研究：Roseen博士提出的K23研究项目将解决有限的 非药物治疗的可用性，以脊椎按摩护理为例，在初级保健设置。 博士Roseen将首先通过流程规划和分析（目标1a）吸引关键利益相关者。第二、 定性方法将用于确定PCP-DC转介的促进因素和障碍（目标1b）。随后他将 在服务不足的三个社区卫生中心设计并试点多层次实施战略 波士顿（Aim 2）该奖项将准备博士Roseen提交未来的竞争性补助金 申请在香港多个地点进行脊骨神经疗法治疗腰痛的混合实施及成效试验， 服务不足的社区。

PROJECT SUMMARY Background: Low back pain (LBP) is common, disabling and costly. Recent American College of Physicians guidelines recommend nonpharmacologic treatments (e.g., spinal manipulation, heat, massage, and acupuncture) as safe and effective first-line approaches for LBP. However, these treatments are most commonly provided to middle- to high- income predominantly white communities, with limited access for low income racially-diverse patients. Chiropractic care, which includes spinal manipulation, is a prototypical example of this care gap; few doctors of chiropractic (DCs) are integrated into medical settings, and primary care providers (PCPs) rarely refer to community-based DCs. Goals and Objectives: Dr. Roseen’s long-term career objective is to become an independent investigator studying the effectiveness and implementation of LBP treatments for underserved populations. This K23 career development award will allow Dr. Roseen to gain advanced skills in conducting pragmatic clinical trials that can assess the real-world effectiveness of LBP treatments and to become competent in the development and assessment of implementation strategies. Career Development Activities: The K23 application will provide structured didactic and hands-on training that will build on Dr. Roseen’s training in chiropractic and epidemiology, through experience and education in process mapping, qualitative methods, implementation strategies, outcome measurement in pragmatic trials, and advanced statistical analyses. The plan will engage Dr. Roseen in robust training activities including mentorship, coursework, research projects, publishing and presenting, workshops and seminars, grant-writing, and responsible conduct of research. Mentors: Dr. Roseen’s mentorship team consists of accomplished scientists from clinical research, health services research, epidemiology, biostatistics, medical anthropology, implementation science, and primary care. Environment: Dr. Roseen will benefit from a comprehensive research training program based at Boston University (BU), Boston Medical Center, BU Clinical Epidemiology Research and Training Unit, BU Center for Improvement and Implementation Science, and BU Clinical and Translational Science Institute. Research: Dr. Roseen’s proposed K23 research project will address the limited availability of nonpharmacologic treatments, using chiropractic care as an exemplar, in primary care settings. Dr. Roseen will first engage key stakeholders through process mapping and analysis (Aim 1a). Secondly, qualitative methods will be used to identify facilitators and barriers of PCP-DC referrals (Aim 1b). He will then design and pilot a multi-level implementation strategy in three community health centers based in underserved neighborhoods in Boston (Aim 2). This award will prepare Dr. Roseen to submit a future competitive grant application for a multi-site hybrid implementation and effectiveness trial of chiropractic care for LBP in underserved communities.