STORM Implementation Program Evaluation

STORM实施计划评估

• 批准号: 9568349
• 负责人: Walid F. Gellad
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9568349
• 关键词: Accidents; Achievement; Acupuncture Therapy; Address; Adherence; Adverse event; Clinical; Clinical Data; Clinical Management; Collaborations; Data; Effectiveness; Equilibrium; Evaluation; Event; Guidelines; Health; Health Services Research; Healthcare Systems; Interview; Learning; Medical center; Mental Health; Methodology; Naloxone; Opioid; Outcome; Overdose; Pain; Pain management; Patients; Physical therapy; Policies; Program Evaluation; Randomized; Research; Research Personnel; Resources; Risk; Risk Estimate; Risk Factors; Risk Management; Safety; Services; Specific qualifier value; Stratification; Structure; Suicide; Surveys; Techniques; Testing; Translating; Uncertainty; Update; Variant; Veterans; Work; adverse outcome; arm; clinical risk; dashboard; design; evidence base; health equity; high risk; implementation research; implementation strategy; improved; individual patient; innovation; insight; non-opioid analgesic; operation; opioid therapy; predictive modeling; prescription opioid; programs; research and development; risk mitigation; tool; uptake

Background and significance: To mitigate the risks of adverse outcomes of opioid therapy, the VA Office of Mental Health Operations (OMHO) and the National Pain Management Program developed a tool to estimate and display the risk of adverse outcomes among patients prescribed opioids. Known as the Stratification Tool for Opioid Risk Management (STORM), the data dashboard displays individual patients’ level of risk, specific clinical risk factors, use of recommended risk mitigation strategies, and pain treatments. STORM is available for use by the field, but there is uncertainty about how to achieve consistent utilization across VA Medical Centers (VAMCs) and maximize its effectiveness in reducing opioid-related adverse events. The overall objective of this service-directed project is to perform, in collaboration with OMHO and the Partnered Evidence-Based Policy Resource Center (PEPReC), a randomized program evaluation that will allow the VA to randomize VAMCs to different STORM rollout conditions using a stepped-wedge design. This innovative feature will allow the VA to evaluate the impact of different rollout conditions on STORM uptake and clinical impact. Methodology and expected results: All VAMCs will receive a policy memorandum mandating STORM-facilitated case reviews of patients at high risk for opioid-related adverse events. VAMCS will be randomized to a policy that has consequences for not meeting target case review completion rates versus a policy without consequences. Subsequently, facilities will be randomized to perform case reviews on patients at the top 1% versus 5% of STORM risk scores in a stepped-wedge fashion. In this partnered evaluation, PEPReC will use VA administrative and clinical data to examine the effects of the randomized rollout on patient-level clinical outcomes. In parallel, a team of investigators from the Center for Health Research and Promotion (CHERP) will conduct facility-level quantitative and qualitative analyses to identify strategies used to implement STORM-facilitated case reviews across VAMCs nationally, as well as implementation barriers and facilitators at a subset of facilities. The CHERP evaluation consists of two overall aims. Aim 1a is to describe the number and type of strategies VAMCs used to implement the STORM policy and compare implementation strategies across the consequences and no consequences rollout arms. Aim 1b is to examine whether the number and type of STORM implementation strategies used by VAMCs predict achievement of the target case-review completion rate outlined in the STORM policy. These Aims will be achieved by conducting an online survey of implementation strategies used across all VAMCs. Regression techniques will be used to compare the number and types of strategies across rollout arms (Aim 1a) and examine their associations with case review completion rates (Aim 1b). Aim 2 is to identify barriers and facilitators to implementing the STORM policy and compare these barriers and facilitators across facilities in each STORM rollout arm. This will be achieved by interviewing key stakeholders at 40 VAMCs nationally using structured interview questions guided by the Consolidated Framework for Implementation Research. This randomized program evaluation provides a unique opportunity to identify the effect of STORM rollout variations and implementation strategies on STORM utilization and outcomes. The evaluation led by CHERP will yield critical insights that will enable OMHO and VA to refine policy implementation, and, synergistic with PEPReC’s evaluation, increase STORM’s clinical impact in accordance with VA priorities for a learning healthcare system.

背景和意义：为了减轻阿片类药物治疗不良结局的风险，VA办公室 心理健康行动（OMHO）和国家疼痛管理计划开发了一种工具， 并显示阿片类药物处方患者的不良结局风险。称为分层工具 对于阿片类药物风险管理（STORM），数据仪表板显示个体患者的风险水平，具体 临床风险因素、使用推荐的风险缓解策略和疼痛治疗。STORM可用 供现场使用，但如何在VA Medical中实现一致的利用率存在不确定性 中心（VAMCs），并最大限度地提高其在减少阿片类药物相关不良事件的有效性。 这一面向服务的项目的总体目标是与OMHO和 伙伴循证政策资源中心（PEPReC），一个随机项目评估，将允许 VA使用阶梯楔形设计将VAMC随机化到不同的STORM展开条件。这 一个创新的功能将允许VA评估不同的推出条件对STORM吸收的影响 临床影响。方法和预期成果：所有脆弱资产管理公司都将收到一份政策备忘录， STORM促进阿片类药物相关不良事件高风险患者的病例审查。VAMCS将在 随机分配到一项政策，该政策对不符合目标病例审查完成率有影响， 政策没有后果。随后，将对机构进行随机化，以对患者进行病例审查 在STORM风险评分的前1%和5%中，以阶梯楔形方式。在这次合作评估中， PEPReC将使用VA管理和临床数据来检查随机部署对 患者水平的临床结局。与此同时，来自健康研究中心的一组调查人员和 促进（CHERP）将进行设施一级的定量和定性分析，以确定所使用的战略 在全国各地的VAMC中实施STORM促进的案例审查，以及实施障碍 和辅导员在一个子集的设施。 该方案的评价包括两个总体目标。目标1a是描述策略的数量和类型 VAMC用于实施STORM政策，并比较 后果和没有后果推出武器。目的1b是检查是否有 VAMC使用的STORM实施战略预测了目标病例审查完成的实现 风暴政策中概述的费率。这些目标将通过进行在线调查来实现， 在所有VAMC中使用的实施策略。回归技术将用于比较 和类型的战略跨推出武器（目标1a），并检查他们的关联与案件审查 完成率（目标1b）。目标2是确定实施风暴政策的障碍和促进因素， 在每个STORM推广组中，比较设施之间的这些障碍和促进因素。这将通过 在全国40个VAMC中使用结构化访谈问题对关键利益相关者进行访谈， 实施研究综合框架。 这种随机的计划评估提供了一个独特的机会，以确定风暴推出的效果 关于STORM利用和结果的变化和实施战略。CHERP领导的评估 将产生关键的见解，使OMHO和VA能够完善政策执行， 通过PEPReC的评估，根据VA学习优先级增加STORM的临床影响 医疗保健系统。