Applying Positive Deviance Methods to Harness Optimal Practices for Effective Pain Management in Community Living Centers

应用正偏差方法来利用最佳实践，在社区生活中心进行有效的疼痛管理

• 批准号: 10668268
• 负责人: Camilla Benedicto Pimentel
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10668268
• 关键词: Adoption; Area; Authorization documentation; Caring; Characteristics; Chronic Disease; Cladribine; Clinical; Clinical effectiveness; Collaborations; Custom; Data; Data Set; Development; Disabled Persons; Disease Management; Diving; Elderly; Evidence based intervention; Excision; Feedback; Future; Geriatrics; Gerontology; Goals; Growth; Health; Health Services Research; Healthcare; Home; Homogeneously Staining Region; Hybrids; Intervention; Intervention Studies; Investments; K-Series Research Career Programs; Knowledge; Lead; Learning; Long-Term Care; Measurement; Measures; Medicare/Medicaid; Mentors; Mentorship; Methodology; Methods; Modeling; Monitor; Nursing Homes; Opioid; Outcome; Pain; Pain Clinics; Pain Measurement; Pain management; Pain quality; Patients; Pattern; Performance; Policies; Practice Management; Preparation; Process; Provider; Qualitative Evaluations; Qualitative Research; Quality of life; Randomized; Reaction; Reporting; Research; Research Design; Risk Adjustment; Structure; Substance Use Disorder; Surveys; System; Testing; Training; Validity and Reliability; Variant; Veterans; Vulnerable Populations; Work; acceptability and feasibility; analytical method; authority; career; clinical implementation; clinical practice; community living; comparative; contextual factors; dashboard; data warehouse; design; deviant; effectiveness testing; evidence base; evidence based guidelines; formative assessment; health care delivery; health care quality; hybrid type 2 design; implementation intervention; implementation science; improved; innovation; organizational structure; pain model; pain outcome; population health; programs; severe mental illness; skills; social; symptom management

Background: Unrelieved pain is highly prevalent and devastating for Veterans in VA’s 134 Community Living Centers (CLCs). Imminent removal of pain as one of the CLC quality measures offers an opportunity, per VA’s Office of Geriatrics and Extended Care (GEC), to develop new, risk-adjusted measures that more accurately characterize CLC pain management. These measures can identify CLCs successful at pain management while minimizing biased underestimates for CLCs with the sickest residents. Then, by diving deeply into structures and processes of high performers, we can learn how to intervene. My background in gerontology, quantitative methods, and implementation science partially prepares me for this work. But I need additional training in risk adjustment, qualitative research, cutting-edge analytic methods, and intervention study designs for the study and my health services research career to succeed. Specific Aims: The proposed CDA simultaneously fills the considerable gaps in my background and provides VA with rigorous, actionable research on which to ground future quality improvement efforts. A social- ecological model frames the work. GEC commits to serving as an invested partner. I have 3 aims, which I will achieve with my mentors and training. 1. Evaluate how risk adjustment changes judgements of CLC pain management performance. 2. Use mixed methods to perform in-depth studies of CLCs with high outlying performance. 3. Adapt an existing, evidence-based intervention comprising lessons learned from “positive deviants.” Methods: Aim 1: Using VA administrative data of CLC residents, I will (1) calculate unadjusted pain measures, (2) apply risk adjustment, (3) assess the measures’ reliability and validity, and (4) identify high and low outlying performance on pain management. Aim 2: I will use quantitative (survey) and qualitative data from staff and residents at 5 top-performing CLCs, contrasted with qualitative data from 5 low-performing CLCs, to develop hypotheses of contextual factors and pain management practices unique to positive deviants. I will test causal relationships using configurational comparative analytic methods. Aim 3: I will adapt an existing nursing home pain management intervention for use in VA CLCs, using empirical evidence from Aim 2 about necessary conditions for optimal pain management. A modified e-Delphi panel of CLC stakeholders and pain management experts will provide feedback on the intervention package’s design. I will use a developmental formative evaluation of qualitative data from staff at 1 low-performing CLC to assess the intervention’s feasibility and acceptability, in preparation for rigorous testing in future work. Expected Results and Next Steps: I will provide GEC with interim deliverables to enable assessment of CLC pain management quality, guide CLC policy, and support clinical practice in CLCs struggling with pain management. Knowledge from this CDA will lead me to develop studies to refine risk adjustment methods for quality measurement in other critical areas and to rigorously evaluate, using a hybrid type II design, clinical effectiveness and implementation of the intervention. Significance & Relevance to Veterans’ Health: Coming at a critical juncture in my VA research career, this timely study responds to the VA priority of Greater Choice for Veterans, ORD’s priority to increase substantial real-world impact of VA research, and HSR&D’s Long-term Care and Opioid/Pain priority domains. Although pain is highly prevalent and debilitating for the 42,000 vulnerable Veterans CLCs serve, almost nothing is systematically known about CLCs’ pain management quality. And current pain measures are about to disappear. This study seizes this opportunity, developing nuanced, VA-specific approaches that are custom- made to reflect the accurate state of CLC pain management and help improve VA long-term care.

背景：未缓解的疼痛非常普遍，对退伍军人来说是毁灭性的，在退伍军人的134个社区生活 中心(CLC)。根据退伍军人事务部的说法，即将消除的疼痛作为CLC质量措施之一提供了一个机会 老年医学和长期护理办公室(GEC)，制定新的、风险调整的措施，以更准确地 描述CLC疼痛管理的特点。这些措施可以识别在疼痛管理方面成功的CLC，同时 最大限度地减少对居民病情最严重的社区的有偏见的低估。然后，通过深入研究建筑物 和过程中的高绩效，我们可以学习如何干预。我的老年学背景，定量的 方法和实现科学使我为这项工作做好了部分准备。但我需要额外的风险培训 研究的调整、定性研究、前沿分析方法和干预研究设计 和我的健康服务研究事业取得成功。 具体目标：拟议的CDA同时填补了我背景中的相当大空白，并提供了 以严谨的、可操作的研究为基础进行未来的质量改进工作。一个社交的- 生态模型为这项工作奠定了基础。GEC承诺成为被投资的合作伙伴。我有三个目标，我会实现的 在我的导师和培训的帮助下取得成功。 1.评估风险调整如何改变对《中图法》疼痛管理绩效的判断。 2.使用混合方法对高性能的CLC进行深入研究。 3.调整现有的、基于证据的干预措施，包括从“积极偏离者”中吸取的教训。 方法：目的1：利用《中图法》住院医师的VA管理数据，(1)计算未调整的疼痛指标， (2)应用风险调整；(3)评估测量的信度和效度；(4)识别高和低边远地区 在疼痛管理方面的表现。目标2：我将使用工作人员的定量(调查)和定性数据 5个表现最好的CLC的居民，与5个表现不佳的CLC的定性数据进行对比，以开发 对背景因素和疼痛管理实践的假设是积极离经者独有的。我要检验一下因果关系 使用构型比较分析方法的关系。目标3：我将改建一家现有的养老院 疼痛管理干预在VA CLCS中的应用，使用来自目标2的关于必要性的经验证据 最佳疼痛管理的条件。修改后的《中图法》利益相关者和疼痛e-Delphi小组 管理专家将就干预方案的设计提供反馈。我会用一个显影的 对1个表现不佳的《中图法》工作人员的定性数据进行形成性评估，以评估干预措施 可行性和可接受性，为今后工作中的严格测试做准备。 预期结果和下一步：我将向GEC提供中期交付成果，以支持对《中图法》的评估 疼痛管理质量，指导CLC政策，并支持与疼痛作斗争的CLC的临床实践 管理层。来自CDA的知识将使我开发研究，以完善以下风险调整方法 其他关键领域的质量测量，并严格评估，使用混合II型设计，临床 干预措施的有效性和实施情况。 对退伍军人健康的意义和相关性：在我退伍军人研究生涯的关键时刻，这 及时研究回应退伍军人更大选择退伍军人退伍军人优先，ORD优先大幅增加 退伍军人事务部研究的现实世界影响，以及HSR&D的长期护理和阿片类药物/疼痛优先领域。虽然 疼痛是非常普遍的，对于42,000名脆弱的退伍军人CLC来说，几乎没有什么是 系统地了解CLCS的疼痛管理质量。而目前的痛苦措施即将 消失吧。这项研究抓住了这个机会，开发了细致入微的、特定于退伍军人管理局的方法，这些方法是定制的 以反映CLC疼痛管理的准确状态，并帮助改善VA的长期护理。

项目成果

Integrating CFIR-ERIC and e-Delphi Methods to Increase Telegeriatrics Uptake.

整合 CFIR-ERIC 和 e-Delphi 方法以提高远程老年医学的采用率。

• DOI: 10.1093/geront/gnac107
• 发表时间: 2023
• 期刊: The Gerontologist
• 作者: Kernan,LauraM;Dryden,EileenM;Nearing,Kathryn;Kennedy,MeaghanA;Hung,Will;Moo,Lauren;Pimentel,CamillaB
• 通讯作者: Pimentel,CamillaB

Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers.

• DOI: 10.1111/1475-6773.14055
• 发表时间: 2023-02
• 期刊: HEALTH SERVICES RESEARCH
• 影响因子: 3.4
• 作者: Dryden, Eileen M.;Kennedy, Meaghan A.;Conti, Jennifer;Boudreau, Jacqueline H.;Anwar, Chitra P.;Nearing, Kathryn;Pimentel, Camilla B.;Hung, William W.;Moo, Lauren R.
• 通讯作者: Moo, Lauren R.

Response to Letter to the Editor: Account for Identity in URM Mentorship.

对致编辑的信的回复：URM 指导中的身份说明。

• DOI: 10.1007/s11606-021-07186-6
• 发表时间: 2022
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Quach,EmmaD;Pimentel,CamillaB;Hartmann,ChristineW
• 通讯作者: Hartmann,ChristineW

The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults.

开发和使用新的视觉工具（REVISIT）来支持参与者回忆：基于网络的老年人访谈研究。

• DOI: 10.2196/52096
• 发表时间: 2024
• 期刊: JMIR formative research
• 影响因子: 2.2
• 作者: Dryden,EileenM;Anwar,Chitra;Conti,Jennifer;Boudreau,JacquelineH;Kennedy,MeaghanA;Hung,WilliamW;Nearing,KathrynA;Pimentel,CamillaB;Moo,Lauren
• 通讯作者: Moo,Lauren