Physician coaching to reduce opioid-related harms

医生指导减少阿片类药物相关危害

• 批准号: 8770938
• 负责人: Randall T Brown
• 金额: $ 22.95万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8770938
• 关键词: Academic Detailing; Address; Adherence; Adopted; Adoption; Affect; Behavior; Chronic; Clinic; Clinical; Communities; Complement; Data; Diffusion; Diffusion of Innovation; Dose; Effectiveness; Engineering; Environment; Evaluation; Evidence based practice; Exercise; Feedback; Focus Groups; Fostering; Goals; Group Processes; Guidelines; Health Personnel; Healthcare; Individual; Interview; Joints; Learning; Maintenance; Medical; Medicine; Methods; Modeling; Morphine; Motivation; Opiate Addiction; Opioid; Outcome; Pain management; Patients; Pharmaceutical Preparations; Physicians; Pilot Projects; Plant Roots; Policies; Primary Care Physician; Primary Health Care; Procedures; Process; Protocols documentation; Provider; Public Health; Records; Recruitment Activity; Research; Research Personnel; Self Determination; Specialist; Structure; System; Techniques; Testing; Time; Training; Translating; Translations; Universities; Variant; Wisconsin; Work; addiction; base; chronic pain; cohort; cost; design; evidence base; implementation science; improved; innovation; medical schools; member; non-cancer pain; opioid misuse; peer; prescription opioid; prescription opioid abuse; public health relevance; randomized trial; stem; theories; tool

DESCRIPTION (provided by applicant): Healthcare is notoriously slow to adopt evidence-based practices (EBPs). This proposal serves the long-term goal of developing a model for promoting the adoption of EBPs in primary care. The objective of this project is to develop and apply such a model to an urgent public health problem: the prescription opioid crisis. Over the past decades, opioids have been used increasingly to treat chronic non-cancer pain. This change in practice has been accompanied by alarming increases in prescription opioid misuse, addiction, and diversion. This work prepares for a subsequent randomized trial that will test the new model against other methods used to promote EBP adoption in primary care. The proposed model is called NIATx-VOP (the Network for Improvement of Addiction Treatment approach to reducing Variation in Opioid Prescribing). NIATx-VOP is designed to improve adherence to clinical guidelines for opioid prescribing. NIATx-VOP builds upon NIATx, a proven method of quality improvement that applies systems engineering principles to addiction treatment. To this approach, the proposal adds an implementation strategy consisting of three innovations: (1) a process for translating clinical guidelines into a checklist-based implementation guide for clinicians, (2) a physician peer coaching model, and (3) implementation support using tools from systems engineering. The standard approach to improving medical practice involves experts producing clinical guidelines based on scientific evidence, and such a guideline has been developed for opioid prescribing for chronic non-cancer pain. This guideline has not been widely implemented in primary care. This project will team the experts who developed the guideline for opioid prescribing with experts in implementation science and primary care to translate the guideline into an actionable, checklist-based implementation guide. Coaching has proven to be effective in improving process goals in healthcare, such as reducing waiting time; it has not yet been proven effective for clinical goals that involve physicians. Diffusion of innovations theory suggests that homophily-the likeness between change agents and those whose behavior they hope to change-may relate to this issue. A physician may be more likely to adopt changes recommended by a physician-coach than by the other healthcare providers who often work as coaches because physicians see physician-coaches as similar to themselves. Evidence also suggests that EBPs must be adapted to a specific context to succeed. In NIATx-VOP, physician coaches will learn tools from systems engineering to help primary care clinics adapt the checklist-based guideline into the workflow and procedures of a clinic. The proposed work consists of 3 specific aims. The first aim focuses on guideline translation and coach training, the second aim focuses on implementing NIATx-VOP in four primary care clinics, and the third aim assesses the feasibility and preliminary effectiveness of the approach using mixed methods. The strategy proposed here is significant because it has the potential to affect not only opioid prescribing but perhaps the adoption of EBPs throughout healthcare.

描述（由申请人提供）：众所周知，医疗保健采用循证实践（EBP）的速度很慢。这项建议有助达致长远目的，即发展一个模式，以披索草根医疗采用改善措施。该项目的目标是开发和应用这样一个模型来解决一个紧迫的公共卫生问题：处方阿片类药物危机。在过去的几十年里，阿片类药物越来越多地用于治疗慢性非癌症疼痛。实践中的这种变化伴随着处方阿片类药物滥用，成瘾和转移的惊人增加。这项工作为随后的随机试验做准备，该试验将测试新模型与用于促进EBP在初级保健中采用的其他方法的对比。该模型被称为NIATx-VOP（减少阿片类药物处方变化的成瘾治疗方法改进网络）。NIATx-VOP旨在提高对阿片类药物处方临床指南的依从性。NIATx-VOP建立在NIATx的基础上，NIATx是一种经过验证的质量改进方法，将系统工程原理应用于成瘾治疗。对于这种方法，该提案增加了一个由三个创新组成的实施策略：（1）将临床指南转化为临床医生基于清单的实施指南的过程，（2）医生同行指导模型，以及（3）使用系统工程工具的实施支持。改善医疗实践的标准方法涉及专家根据科学证据制定临床指南，并且已经为慢性非癌症疼痛的阿片类药物处方制定了这样的指南。该指南尚未在初级保健中广泛实施。该项目将与制定阿片类药物处方指南的专家以及实施科学和初级保健专家合作，将该指南转化为可操作的，基于清单的实施指南。教练已被证明是有效的，在改善医疗保健的过程目标，如减少等待时间;它尚未被证明有效的临床目标，涉及医生。创新扩散理论表明，同质性--变革推动者和他们希望改变其行为的人之间的相似性--可能与这个问题有关。医生可能更有可能采用医生教练推荐的改变，而不是其他经常担任教练的医疗保健提供者，因为医生认为医生教练与自己相似。有证据还表明，循证生产方式必须适应具体情况才能取得成功。在NIATx-VOP中，医生教练将学习系统工程的工具，以帮助初级保健诊所将基于检查表的指南适应诊所的工作流程和程序。拟议的工作包括三个具体目标。第一个目标侧重于指南翻译和教练培训， 第二个目标是在四个初级保健诊所实施NIATx-VOP，第三个目标是评估使用混合方法的可行性和初步有效性。这里提出的策略是重要的，因为它不仅有可能影响阿片类药物处方，而且可能影响整个医疗保健中EBP的采用。