Complementary and Integrative Health Stepped Care for Co-occurring Chronic Pain and PTSD

针对同时发生的慢性疼痛和创伤后应激障碍 (PTSD) 的补充和综合健康阶梯护理

• 批准号: 10663398
• 负责人: David E Reed
• 金额: $ 8.59万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10663398
• 关键词: Adherence; Administrator; Affect; Alaska; Award; Back; Caring; Characteristics; Chronic; Chronic Post Traumatic Stress Disorder; Clinic; Clinical; Clinical Trials Design; Collaborations; Community Healthcare; Complementary Health; Complex; Data; Data Analyses; Dedications; Development; Diagnostic Factor; Ensure; Evaluation; Faculty; Feedback; Focus Groups; Foundations; Funding; Goals; Grant; Health system; Healthcare Systems; Human Subject Research; Idaho; Individual; Institution; Integrative Medicine; Intervention; Interview; Learning; Measurement; Measures; Mental Health; Mentors; Mentorship; Mind-Body Intervention; Modeling; Montana; National Center for Complementary and Integrative Health; Nonpharmacologic Therapy; Pain; Pain interference; Pain management; Participant; Pathway interactions; Patients; Personal Satisfaction; Phase; Positioning Attribute; Post-Traumatic Stress Disorders; Pragmatic clinical trial; Primary Care; Process; Provider; Randomized; Readiness; Recording of previous events; Research; Research Personnel; Resources; Rural; Site; Structure; Symptoms; System; Technology; Testing; Training; Treatment Protocols; Use Effectiveness; Visualization; Washington; Writing; Wyoming; career; career development; chronic pain; chronic pain management; chronic pain patient; design; dissemination science; early phase trial; evidence base; experience; implementation science; improved; interest; learning strategy; member; mind/body; mindfulness meditation; novel; novel strategies; opioid epidemic; pain outcome; patient population; patient response; physical conditioning; pilot test; pilot trial; pragmatic trial; primary care clinic; primary care setting; primary care team; professor; programs; prototype; randomized effectiveness trial; rumination; rural setting; satisfaction; treatment as usual; treatment planning; treatment response; treatment strategy; trial design; user centered design

Project Summary/Abstract My application for a Pathway to Independence Award represents the ideal next step toward reaching my goal of becoming a leading independent investigator focused on the development and evaluation of systems-based approaches for effectively delivering CIH interventions for common chronic conditions. The current application proposes the development and pragmatic pilot testing of a novel CIH-based stepped care approach for co- occurring chronic pain and PTSD. The aims of the proposal strategically align with my specific career development goals of gaining expertise in 1) systems-based care models for complex co-occurring physical and mental health conditions, 2) pragmatic clinical trial design for CIH interventions, and 3) user-centered design strategies for learning health systems. Also included is a professional development goal to 4) ensure my readiness to transition into an independent researcher and faculty member at the rank of Assistant Professor. In addition, the training plan includes 2 goals in the R00 phase of the award: 5) successfully transition into an Assistant Professor position and maintain a successful independent research program; and, 6) conduct a pilot randomized effectiveness trial and use pilot data to write and submit a competitive R01-level grant to NCCIH. The training plan includes an excellent research mentorship team with an established history of consistent independent federal funding and mentorship to ensure that these 6 goals are met. Dr. Steve Zeliadt (Primary Mentor) is an expert in pragmatic trial design, dissemination and implementation science, and quantitative data analysis; Dr. Kurt Kroenke (Co-Mentor) is an expert in systems-based and stepped care models within primary care settings for patients with chronic physical and mental health conditions; and Dr. Rhonda Williams (Co- Mentor) is an expert in pragmatic clinical trial design for CIH interventions and the development, treatment, and theoretical underpinnings of CIH interventions for individuals with complex symptom presentations. In Aim 1, we will use patient semi-structured interviews and clinic focus groups to identify provider strategies and patient perspectives relevant to treating co-occurring chronic pain and PTSD in a primary care clinic. Using proven stepped care approaches developed by mentor Dr. Kroenke for pain and by consultant Dr. Zatzick for PTSD as the foundation, our team will develop a CIH-based stepped care approach for co-occurring chronic pain and PTSD in primary care guided by current evidence of CIH interventions while including patient, provider, and clinic input. In Aim 2, we will iteratively refine the protoype using user-centered design strategies. In Aim 3, we will conduct a pragmatic pilot trial of our CIH-based stepped care approach v. treatment as usual in two primary care settings (one rural, one urban). The experiential components of each aim, combined with my mentorship plan, will ensure my readiness for independence as an expert in the development and evaluation of systems-based approaches for effectively delivering CIH interventions. The training goals and research aims align with the important NCCIH priorities of CIH interventions for co-occurring chronic pain and PTSD and well-being.

项目总结/摘要 我申请独立之路奖代表了实现我目标的理想下一步 成为领先的独立调查员，专注于开发和评估基于系统的 为常见慢性病有效提供CIH干预措施的方法。当前应用程序 提出了一种新的基于CIH的阶梯式护理方法的开发和务实的试点测试， 慢性疼痛和创伤后应激障碍该提案的目标与我的具体职业战略一致 发展目标是获得以下方面的专业知识：1）复杂的同时发生的身体和 心理健康状况，2）CIH干预措施的实用临床试验设计，以及3）以用户为中心的设计 学习卫生系统的战略。此外，还包括一个职业发展目标，以确保我的 准备过渡到一个独立的研究人员和教员在助理教授的职级。在 此外，培训计划包括R00阶段的两个目标：5）成功过渡到 助理教授的立场，并保持一个成功的独立研究计划;和，6）进行试点 随机有效性试验，并使用试点数据编写和提交一个有竞争力的R01级拨款NCCIH。 培训计划包括一个优秀的研究导师团队，具有一贯的历史， 独立的联邦资助和指导，以确保实现这6个目标。Steve Zeliadt博士（小学 Mentor）是实用试验设计、传播和实施科学以及定量数据方面的专家 Kurt Kroenke博士（共同导师）是初级保健中基于系统和阶梯式护理模式的专家 慢性身心健康状况患者的护理环境;和Rhonda威廉姆斯博士（联合国， Mentor）是CIH干预措施的实用临床试验设计以及CIH开发、治疗和 CIH干预具有复杂症状表现的个体的理论基础。目标1： 将使用患者半结构化访谈和诊所焦点小组来确定提供者策略和患者 相关的观点来治疗共同发生的慢性疼痛和创伤后应激障碍在初级保健诊所。通过使用行之有效的 由导师Kroenke博士为疼痛和顾问Zatzick博士为PTSD开发的分步护理方法， 基金会，我们的团队将开发一个基于CIH的阶梯式护理方法，用于同时发生的慢性疼痛， 根据CIH干预措施的现有证据指导初级保健中的PTSD，同时包括患者，提供者和诊所 输入.在目标2中，我们将使用以用户为中心的设计策略迭代改进原型。在目标3中，我们 在两个初级保健中心进行一项务实的试点试验， （一个城市，一个农村）。每个目标的经验成分，结合我的导师计划， 我将确保我作为开发和评估基于系统的 有效实施CIH干预措施的方法。培训目标和研究目标与 重要的NCCIH CIH干预的优先事项为共同发生的慢性疼痛和创伤后应激障碍和福祉。