Engaging Veterans Seeking Service-Connection Payments in Pain Treatment

让寻求服务连接付款的退伍军人参与疼痛治疗

• 批准号: 9445873
• 负责人: Steve Martino
• 金额: $ 52.4万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2019-08-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9445873
• 关键词: Age; Alcohol or Other Drugs use; Algorithms; Award; Back; Behavior; Brief Pain Inventory; Caring; Chronic; Clinical; Clinical Trials; Communication; Conduct Clinical Trials; Cost Analysis; Counseling; Data; Distress; Early Intervention; Effectiveness; Electronic Health Record; Evaluation; Financial compensation; Health; Health Services Accessibility; Healthcare Systems; Human Resources; Individual; Injury compensation; Intervention; Interview; Joints; Measures; Mediating; Mediator of activation protein; Medical Records; Medical center; Military Personnel; Modality; Multi-Institutional Clinical Trial; Musculoskeletal; Musculoskeletal Diseases; Nail plate; Natural Language Processing; Neck; New England; Opioid; Outcome; Outcome Assessment; Outcome Measure; Pain; Pain interference; Pain management; Patient Self-Report; Phase; Phonation; Populations at Risk; Preparation; Procedures; Professional counselor; Protocols documentation; Quality of life; Randomized; Records; Recruitment Activity; Risk; Secure; Services; Severities; Site; Site Visit; Source; Structure; Telephone; Testing; Text; Toxicology; Veterans; base; chronic pain; cost; cost effective; cost effectiveness; design; experience; functional improvement; high risk; improved; informant; innovation; motivational enhancement therapy; pain symptom; payment; pragmatic trial; primary outcome; psychologic; screening; screening, brief intervention, referral, and treatment; secondary outcome; service utilization; substance abuse treatment; substance misuse; symptomatic improvement; treatment as usual; willingness to pay

Abstract In 2015 alone, 97,223 new Veterans under age 35 began receiving compensation for injuries related to their military service. In total, there are 559,999 post-9/11 Veterans being compensated for back or neck conditions, and a partially overlapping 596,250 for limitation of flexion in joints. Veterans seeking compensation for musculoskeletal conditions often develop chronic pain and are at high risk for substance misuse. Early intervention is needed to arrest worsening pain and risky substance use, particularly among post-9/11 Veterans for whom engagement in non-pharmacological pain treatment has the potential to improve their overall quality of life and spare them the complications of opioid treatments. The service-connection application is an ideal point-of-contact for initiating early intervention treatments for these at-risk Veterans. We propose to test the effectiveness and cost-effectiveness of Screening, Brief Intervention and Referral to Treatment for Pain Management (SBIRT-PM), designed to reduce pain and risky substance use. In brief, the counselor explains that treating both physical and psychological aspects of pain leads to the best outcomes, outlines what VA (and non-VA if preferred) services are available to Veterans, explains that substances are sometimes used for pain relief, and segues into traditional SBIRT. SBIRT-PM's efficacy is supported by a completed clinical trial of 101 Veterans applying for service-connection for MSD, and by studies showing the efficacy of SBIRT for people with risky substance use and of Motivational Interviewing for engagement in non-pharmacological pain care. The study will involve a two-year period to arrange for clinicians at a single “hub” site to counsel Veterans throughout New England by phone with SBIRT-PM, and a four-year period to conduct the clinical trial and disseminate its findings. During the two-years of preparation for the clinical trial, the team will prepare SBIRT-PM for implementation by establishing communication (Relational Coordination is the theoretical framework) between the “hub” where the SBIRT-PM clinician is sited and the “spoke” sites, establishing study- related procedures, and piloting the intervention at each of the eight VA medical centers in New England. For the full clinical trial, we will randomize 1200 Veterans applying for compensation related to MSD to either SBIRT-PM or Usual Care (UC) across eight VA medical centers in New England. Outcome assessment by phone will occur at 12 and 36-week follow-ups, and will be corroborated with other sources of information ---the electronic health record and toxicology testing of nail clippings. We hypothesize that, compared to Usual Care, SBIRT-PM will be more effective and cost-effective in improving Veterans' pain and substance use. We further hypothesize that a mediator of these improvements will be use of non-pharmacological services, as extracted from VA records from structured data fields and from narrative text in the medical record using an innovative natural language processing algorithm. Screening and referral to treatment at service-connection examinations can transform a widely-used point of entry to VA into a health-promoting encounter.

抽象的 仅在 2015 年，就有 97,223 名 35 岁以下的新退伍军人开始获得与其相关的伤害赔偿 兵役。总共有 559,999 名 9/11 后退伍军人因背部或颈部疾病获得补偿， 以及部分重叠的596,250，用于限制关节的弯曲。退伍军人寻求赔偿 肌肉骨骼疾病通常会导致慢性疼痛，并且滥用药物的风险很高。早期的 需要进行干预来阻止日益恶化的疼痛和危险药物的使用，特别是在 9/11 事件后 退伍军人参与非药物疼痛治疗有可能改善他们的疼痛 整体生活质量并使他们免受阿片类药物治疗的并发症。服务连接应用程序 是为这些高危退伍军人启动早期干预治疗的理想接触点。我们建议 测试疼痛筛查、简短干预和转诊治疗的有效性和成本效益 管理 (SBIRT-PM)，旨在减少疼痛和危险物质的使用。简而言之，辅导员解释道 治疗疼痛的生理和心理方面会带来最佳结果，概述了 VA （如果愿意，也可以是非退伍军人）为退伍军人提供服务，解释说物质有时用于 缓解疼痛，然后进入传统的 SBIRT。 SBIRT-PM 的功效得到了一项已完成的临床试验的支持 101 名退伍军人申请 MSD 服务连接，研究表明 SBIRT 对 有危险药物使用和参与非药物疼痛的动机访谈的人 关心。该研究将为期两年，安排临床医生在一个“中心”地点提供咨询 新英格兰各地的退伍军人通过电话与 SBIRT-PM 联系，并在四年内进行临床试验 并传播其研究结果。在为期两年的临床试验准备期间，团队将准备 SBIRT-PM通过建立通信来实现（关系协调是理论上的 框架）在 SBIRT-PM 临床医生所在的“中心”和“辐射”站点之间建立研究- 相关程序，并在新英格兰的八个退伍军人管理局医疗中心进行试点干预。为了 在完整的临床试验中，我们将随机分配 1200 名申请 MSD 相关补偿的退伍军人 新英格兰八个 VA 医疗中心的 SBIRT-PM 或常规护理 (UC)。结果评估由 电话将在 12 周和 36 周的随访中进行，并将与其他信息来源得到证实—— 电子健康记录和指甲剪毒理学测试。我们假设，与常规护理相比， SBIRT-PM 在改善退伍军人的疼痛和药物使用方面将更加有效且更具成本效益。我们进一步 假设这些改进的中介因素将是使用非药物服务，如摘录的 使用创新的方法从结构化数据字段和医疗记录中的叙述文本中提取 VA 记录 自然语言处理算法。在服务连接处进行筛查和转诊治疗 检查可以将广泛使用的 VA 切入点转变为促进健康的机会。