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.

摘要 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受伤有关的赔偿。 服兵役。总共有559,999名9/11事件后的退伍军人因背部或颈部疾病而获得赔偿， 以及用于限制关节弯曲的部分重叠596、250。退伍军人寻求赔偿 肌肉骨骼疾病往往发展为慢性疼痛，并有滥用药物的高风险。早期 需要进行干预，以阻止疼痛恶化和危险药物使用，特别是在9/11后 参与非药物疼痛治疗的退伍军人有可能改善他们的 整体生活质量，避免阿片类药物治疗的并发症。服务连接应用程序 是一个理想的接触点，为这些处于危险之中的退伍军人开始早期干预治疗。我们建议 测试筛查、短暂干预和转诊治疗疼痛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，顾问解释说 治疗疼痛的生理和心理方面导致最好的结果，概述了VA (and非VA，如果首选）服务提供给退伍军人，解释说，物质有时被用于 缓解疼痛，并进入传统的SBIRT。SBIRT-PM的疗效得到了一项已完成的临床试验的支持， 101退伍军人申请服务连接MSD，并通过研究显示SBIRT的疗效， 有危险物质使用和参与非药物性疼痛的动机性访谈的人 在乎这项研究将涉及两年的时间来安排临床医生在一个单一的“枢纽”网站的咨询 整个新英格兰的退伍军人通过电话与SBIRT-PM，并在四年内进行临床试验 并传播其发现。在两年的临床试验准备期间， SBIRT-PM通过建立通信来实现（关系协调是理论上的 在SBIRT-PM临床医生所在的“枢纽”和“辐条”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的每一个进行干预试点。为 在完整的临床试验中，我们将随机选择1200名申请与默沙东有关的赔偿的退伍军人， 新英格兰八个VA医疗中心的SBIRT-PM或医疗护理（UC）。结果评估 电话将在12周和36周随访时进行，并将与其他信息来源进行证实- 电子健康记录和指甲屑的毒理学测试。我们假设，与家庭护理相比， SBIRT-PM在改善退伍军人的疼痛和物质使用方面将更加有效和具有成本效益。我们进一步 假设这些改善一个中介将是使用非药物服务，如提取的 从结构化数据字段的VA记录和从病历中的叙述性文本，使用创新的 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入口点转变为促进健康的遭遇。