Addressing Disparities In Pain Management

解决疼痛管理方面的差异

• 批准号: 10642345
• 负责人: Sarah Javier
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10642345
• 关键词: Academic Detailing; Address; Adoption; Affect; Area; Automobile Driving; Belief; Biological; Caring; Cessation of life; Chronic; Clinic; Color; Data; Decision Aid; Dedications; Development; Disparity; Dose; Education; Ethnic Origin; Evaluation; Evidence based practice; Funding; Future; Gender; Goals; Guidelines; Health system; Heterogeneity; Hospitalization; Individual; Inequity; Interview; Investigator-Initiated Research; Logistic Regressions; Maps; Measures; Mentorship; Methodology; Methods; Monitor; Needs Assessment; Opioid; Outcome; Pain; Pain management; Patient Selection; Patients; Pharmacological Treatment; Population; Protocols documentation; Provider; Race; Reporting; Research; Research Methodology; Research Personnel; Research Proposals; Resources; Sampling; Self Efficacy; Site; Skin; Source; Surveys; Testing; Training; Treatment Protocols; Veterans; Woman; Women' s Health; access disparities; addiction; chronic pain; chronic pain management; data warehouse; debilitating pain; empowerment; evidence base; experience; future implementation; gender difference; health equity; implementation design; implementation facilitators; implementation outcomes; implementation science; implementation strategy; innovation; marginalized population; men; military veteran; non-cancer chronic pain; opioid epidemic; opioid therapy; outreach; patient outreach; psychologic; racial bias; social; stakeholder perspectives; stem; uptake; whole health

Background: Disparities in pain treatment suggest that Veterans of color and women Veterans (i.e., “diverse Veterans” in this CDA) are subject to unequal treatment when seeking pain care at VA. Mounting evidence points to the importance of guideline-concordant, evidence-based non-pharmacological pain treatments (NPTs) in the management of chronic pain, yet these treatments are not reaching diverse Veterans. Implementation mapping can be used to rigorously plan implementation of evidence-based practices (e.g., NPTs). Using this approach, one can identify key barriers and facilitators to implementation of evidence-based practices and map them to relevant implementation strategies and target users. The purpose of this CDA is to develop and test a tailored implementation blueprint for increasing NPT use among diverse Veterans. Significance/Impact: Over 2 million Veterans suffer from chronic pain. Over the next four decades, Veterans of color are projected to grow exponentially and there is far more racial/ethnic heterogeneity among women than men in the VA. There is a critical need to identify effective implementation strategies that can be used to disseminate NPTs in order to meet the needs of future diverse Veterans with chronic pain. Innovation: This proposal offers three innovations: 1) An integrated conceptual framework mapping key health equity domains to implementation science solutions; 2) An implementation blueprint developed using a comprehensive and rigorous pre-implementation planning approach (i.e., implementation mapping) that is informed by mixed methods research with target users; and 3) a strong focus on health equity and inclusion of diverse Veteran engagement via operational partnerships during each stage of research. Specific Aims: 1) Aim 1: Understand and identify factors driving NPT use among diverse Veterans using mixed methods; Sub-Aim 1.1: Identify sites at which diverse Veterans are not using NPTs despite NPTs being available; Sub-Aim 1.2: Evaluate multi-level stakeholder perspectives necessary for designing an implementation blueprint tailored for diverse Veterans; Sub-Aim 1.3: Assess disparities in NPT use in VA administrative data; 2) Aim 2: Use implementation mapping to identify core and non-core components of NPT uptake and design an implementation blueprint tailored for diverse Veterans; Sub-Aim 2.1: Generate a matrix of change outcomes resulting from use of a tailored implementation blueprint; Sub-Aim 2.2: Develop protocols and materials comprising the tailored implementation blueprint; and 3) Aim 3: Measure pre-implementation outcomes of the tailored blueprint developed in Aim 2, including feasibility, acceptability, appropriateness, dose, complexity, and self-efficacy among target users. Methodology: In Aim 1.1, a quantitative sampling strategy using VA administrative will inform the selection of four implementation sites. In Aim 1.2, qualitative interviews will identify factors driving NPT use among diverse Veterans, which will, in turn, inform the selection of patient and organizational factors in Aim 1.3 quantitative analyses. In Aim 2.1, we will use implementation mapping and synthesize findings from Aim 1 to develop a needs assessment and design an implementation blueprint. In Aim 2.2, we will develop blueprint protocols and materials comprising patient- and provider-facing implementation strategies that promote the ideas of “push” (e.g., academic detailing) and “pull” (e.g., direct-to-patient outreach) In Aim 3, the implementation blueprint will be assessed among providers and diverse Veterans for pre-implementation outcomes of acceptability, feasibility, appropriateness, dose, and complexity using evaluation surveys and interviews. Next Steps/Implementation: These findings will inform the development of two HSR&D investigator-initiated research (IIR) proposals to be submitted in Years 3 and 5 of the CDA. Notably, this approach can inform the future implementation of evidence-based care across VA and other health systems.

背景：疼痛治疗的差异表明，有色人种退伍军人和女性退伍军人（即，“多样化 退伍军人”在这个CDA）受到不平等的待遇时，寻求疼痛护理在VA。越来越多的证据 指出了与指南一致、基于证据的非药物疼痛治疗的重要性 （NPTs）在慢性疼痛的管理，但这些治疗没有达到不同的退伍军人。 实施规划可用于严格规划循证实践的实施（例如， NPT）。使用这种方法，人们可以确定实施循证医学的主要障碍和促进因素。 并将其映射到相关的实施战略和目标用户。本CDA的目的是 制定和测试一个量身定制的实施蓝图，以增加不同退伍军人对《不扩散条约》的使用。 意义/影响：超过200万退伍军人患有慢性疼痛。在接下来的四十年里，退伍军人 预计有色人种的人数将呈指数级增长，女性中的种族/民族异质性要大得多。 比退伍军人管理局的男人多迫切需要确定有效的执行战略， 传播NPTs，以满足未来各种慢性疼痛退伍军人的需求。 创新：该提案提供了三项创新：1）一个综合概念框架， 公平领域的实施科学解决方案; 2）使用 全面和严格的实施前规划方法（即，实现映射），即 通过对目标用户的混合方法研究提供信息; 3）高度重视健康公平和纳入 在研究的每个阶段，通过运营伙伴关系实现多样化的退伍军人参与。 具体目标：1）目标1：了解和确定各种退伍军人使用《不扩散核武器条约》的驱动因素， 混合方法;子目标1.1：确定不同退伍军人不使用NPT的地点，尽管NPT 次级目标1.2：评估设计一个可持续发展战略所需的多层次利益攸关方视角 为不同退伍军人量身定制实施蓝图;次级目标1.3：评估退伍军人事务部在使用《不扩散条约》方面的差异 2）目标2：利用执行情况摸底调查确定《不扩散条约》的核心和非核心组成部分 采用并设计一个针对不同退伍军人的实施蓝图;次级目标2.1：生成一个矩阵 使用定制的实施蓝图产生的变化结果;次级目标2.2：制定协议 3）目标3：衡量实施前的情况 目标2中制定的定制蓝图的成果，包括可行性、可接受性、适当性， 剂量、复杂性和目标用户的自我效能。 方法：在目标1.1中，使用VA管理的定量抽样策略将为选择 四个实施现场。在目标1.2中，定性访谈将确定推动不同国家使用《不扩散核武器条约》的因素， 退伍军人，这将反过来，告知目标1.3定量中的患者和组织因素的选择 分析。在目标2.1中，我们将使用实现映射并综合目标1的发现， 需要评估和设计实施蓝图。在目标2.2中，我们将开发蓝图协议， 材料包括面向患者和提供者的实施战略，促进“推动”的想法 (e.g.,学术细节）和“拉”（例如，在目标3中，实施蓝图将 在提供者和不同的退伍军人中评估实施前的可接受结果， 可行性，适当性，剂量和复杂性，使用评估调查和访谈。 下一步/实施：这些发现将为两个HSR&D发电机的开发提供信息。 在CDA的第3年和第5年提交的研究（IIR）提案。值得注意的是，这种方法可以告知 未来在VA和其他卫生系统实施循证护理。