Identifying and Promoting Quality Low Back Pain Care by Chiropractors

摘要 高质量的腰痛（LBP）护理应包括非药物干预作为主要的治疗方法。 使用经验证的患者报告结局指标的管理策略和系列疼痛评估 （PROMs）。PROM是由患者完成的标准化、经验证的问卷， 他们对自己健康状况的看法。除了作为高质量LBP护理的标志外，PROM的使用 可能通过促进共同决策和沟通来影响疼痛相关的临床实践 患者和医疗保健专业人员，使进展评估，以评估治疗计划 适当性，并可能积极影响健康状况（包括疼痛水平和疼痛相关能力）。 然而，人们对在通常做法中将推荐使用的方案主管机构翻译的程度知之甚少， 脊椎按摩师本提案中研究的目标是描述LBP中使用经过验证的PROM 管理退伍军人健康管理局（VHA）脊椎按摩诊所，并进行可行性试点测试， 即时CDS警报，以便于在文档工作流程中使用。技术的适应 接受模式将作为脊医增加使用专业进修课程的理论基础， 一种基于技术的干预。在目标1中，我们将量化当前国家文件中验证的 VHA脊医在LBP护理期间使用自然语言处理电子健康记录的PROM 数据在目标2中，我们将调查VHA脊医，以了解 用于PROM使用和临床决策支持的文档和临床工作流程。这种“以社区为基础” 利益相关者参与的方法将评估电子信息的可接受性、可用性和适当性。 基于健康记录临床决策支持警报作为促进PROM使用的干预。在目标3中，我们 在四个VHA脊椎治疗中对开发的CDS警报进行单臂可行性和可接受性试验 临床，测量初步干预措施的采用，可行性和可接受性作为结果。拟议 研究将评估可行性，并改进方法，以支持全面的务实试验，以评估 CDS警报干预对高质量LBP护理提供的影响，包括临床医生使用PROM作为 质量标志，以及脊椎按摩诊所和其他护理机构中的患者结局， LBP。作为一个职业发展奖的建议，这个项目将准备博士科尔曼的职业生涯， 独立的科学家，并告知未来的试验研究使用即时护理决策支持工具，以指导 LBP管理。他组建了一个由导师和合作者组成的团队，他们在医疗领域拥有不同的专业知识。 信息学，临床研究，脊椎治疗护理和干预发展，以指导他过渡到一个 独立调查员在这个指导奖，他将获得和提高他的知识和技能， 临床研究，包括实用的临床试验和实施科学。

Abstract High-quality low back pain (LBP) care should include nonpharmacological interventions as the primary management strategy and serial pain assessment using validated patient reported outcome measures (PROMs). PROMs are standardized, validated questionnaires completed by patients to identify and quantify their perceptions of their health status. In addition to serving as a marker of high-quality LBP care, PROM use may impact pain-related clinical practice by facilitating shared decision making and communication between patients and healthcare professionals, enabling progress assessment to evaluate treatment plan appropriateness, and possibly positively influencing health status (including pain level and pain-related ability). However, little is known about the extent of translation of the recommended use of PROMs in usual practice by chiropractors. The goal of the research in this proposal is to describe the use of validated PROMs in LBP management in Veterans Health Administration (VHA) chiropractic clinics and perform feasibility pilot testing of a point-of-care CDS alert to facilitate use in the documentation workflow. An adaptation of the Technology Acceptance Model will be used as the theoretical basis for increasing use of PROMs by chiropractors through a technology-based intervention. In Aim 1, we will quantify the current national documentation of validated PROMs during LBP care by VHA chiropractors using natural language processing on electronic health record data. In Aim 2, we will survey VHA chiropractors to understand priorities and considerations in the documentation and clinical workflow for PROM use and clinical decision support. This “community-based” approach to stakeholder engagement will assess the acceptance, usability, and appropriateness of electronic health record based clinical decision support alert as an intervention to promote PROM use. In Aim 3, we will conduct a single-arm feasibility and acceptability pilot of the developed CDS alert in four VHA chiropractic clinics, measuring preliminary intervention adoption, feasibility, and acceptability as outcomes. The proposed research will evaluate the feasibility and refine methods in support of a full-scale pragmatic trial to assess the effects of a CDS alert intervention on high-quality LBP care delivery, including clinician use of PROMs as a quality marker, and on patient outcomes in chiropractic clinics and other care settings commonly managing LBP. As a career development award proposal, this project will prepare Dr. Coleman for a career as an independent scientist and inform future trials studying the use of point-of-care decision support tools to guide LBP management. He has assembled a team of mentors and collaborators with diverse expertise in medical informatics, clinical research, chiropractic care, and intervention development to guide his transition to an independent investigator. During this mentored award, he will acquire and enhance his knowledge and skills in clinical research, including pragmatic clinical trials and implementation science.