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

扩展可互操作的临床决策支持，以实现以患者为中心的慢性疼痛护理

• 批准号: 10488223
• 负责人: Christopher Albert Harle
• 金额: $ 98.78万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-13 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10488223
• 关键词: Scaling; Interoperable; Clinical; Decision; Support

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.

项目概要/摘要 美国继续面临与慢性疼痛和阿片类药物过量相关的公共卫生危机。三十 % 的美国人患有慢性非癌症疼痛，每年造成 6000 亿美元的损失。大多数患者患有 慢性疼痛首先求助于初级保健临床医生，他们必须根据以下情况从多种治疗方案中进行选择 相对风险和获益、患者病史、症状和目标。最近，随着阿片类药物相关风险的关注， 处方量有所下降。然而，临床专家对此反驳道，他们担心一些患者 与阿片类药物相关的益处大于风险，正在不适当地停止使用阿片类药物。很遗憾， 初级保健临床医生缺乏可用的工具来帮助他们与患者合作选择疼痛治疗方法 根据患者病史、症状和目标，最好地平衡风险和收益的选项。因此， 初级保健临床医生和患者将受益于以患者为中心的临床决策支持（CDS） 共享决策过程。这项为期三年的提案的目标是研究适应和 实施现有的可互操作的 CDS 工具，用于疼痛治疗共享决策，并定制 OneFlorida 临床研究联盟的新临床环境中的实施支持。我们的中央 假设是定制的实施支持将增加 CDS 的采用和共享决策。我们 进一步假设，共同决策的增加将改善患者的治疗结果、疼痛和 身体机能。拟议的研究建立在我们团队近十年的研究设计历史基础上， 实施并评估用于疼痛护理的 CDS。该研究响应了 AHRQ 的 PA-20-074 并与 AHRQ 对阿片类药物相关研究 (NOT-HS-18-015) 以及快速医疗互操作性的使用的兴趣 资源 (FHIR) (NOT-HS-19-020)。 CDS 的实施将以探索、准备、 实施、维持（EPIS）框架。评估将按范围、有效性、 采用、实施和维护 (RE-AIM) 框架。我们的具体目标是：1）适应和定制 Pain Manager 是 AHRQ 的可互操作 CDS 工具，用于在附属于 AHRQ 的初级保健诊所中实施 OneFlorida 临床研究联盟； 2) 评估定制实施支持对疼痛的影响 经理采用疼痛治疗共同决策； 3) 建立可行性并获得 初步数据，为针对疼痛管理器有效性的多站点实用试验做准备 针对共同决策以及患者报告的疼痛和身体功能提供量身定制的实施支持。 该研究将为在新的临床环境中实施可互操作的 CDS 的策略提供证据 跨越不同类型的电子健康记录。该研究还将为量身定制的实施策略提供信息 在随后的混合有效性实施试验中进行进一步测试。这些努力将共同引领 患者、临床医生和卫生系统可以用来改善的重要新技术和证据 照顾数百万遭受疼痛和其他慢性病困扰的美国人。