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

项目总结 背景：下腰痛(LBP)是一种常见的、致残的和昂贵的疾病。新近的美国医师学院 指南建议非药物治疗(例如，脊柱推拿、热疗、按摩和 针灸)是治疗LBP安全有效的一线方法。然而，这些治疗方法是大多数 通常提供给以白人为主的中高收入社区，低收入者获得的机会有限 收入不同种族的患者。脊椎疗法，包括脊椎手法，是一个典型的 这种护理差距的例子；很少有脊骨疗法(DC)的医生被整合到医疗环境中，并且初级 护理提供者(PCP)很少提到以社区为基础的DC。目标和目的：罗辛博士的长期 职业目标是成为一名独立的调查员，研究 针对服务不足人群的LBP治疗。这项K23职业发展奖将使罗辛博士获得 具有进行实用临床试验的高级技能，可评估LBP的实际效果 并在制定和评估实施战略方面具有能力。 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， 将以Roseen博士在脊椎疗法和流行病学方面的培训为基础，通过以下方面的经验和教育 过程映射、定性方法、实施策略、务实试验的结果衡量、 和高级统计分析。该计划将使罗森博士参加强有力的培训活动，包括 辅导、课程作业、研究项目、出版和演示、讲习班和研讨会、赠款撰写、 以及负责任的研究行为。导师：罗辛博士的导师团队由有成就的 来自临床研究、卫生服务研究、流行病学、生物统计学、医学人类学的科学家， 实施科学和初级保健。环境：罗斯恩博士将从一项全面的 波士顿大学(BU)、波士顿医学中心、波士顿大学临床流行病学研究培训计划 研究和培训单位，BU改进和实施科学中心，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 在初级保健环境中，以脊椎疗法为范例的非药物治疗的可用性。 罗斯恩博士将首先通过流程规划和分析(目标1a)与主要利益攸关方接触。第二， 将使用定性方法来确定初级方案-转介的促进者和障碍(目标1b)。到时候他会的 设计并试行基于服务不足的三个社区卫生中心的多层次实施战略 波士顿的社区(目标2)。这一奖项将为罗斯恩博士提交未来的竞争性赠款做好准备 背脊疗法在腰背痛多点混合性实施及效果试验中的应用 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.