Identifying and Promoting Quality Low Back Pain Care by Chiropractors

摘要 高质量的下腰痛(LBP)护理应包括作为主要的非药物干预 使用经过验证的患者报告结果评估的管理策略和系列疼痛评估 (舞会)。PROM是由患者填写的标准化、有效的问卷，用于识别和量化 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使用 可能会影响与疼痛相关的临床实践，因为它促进了 患者和医疗保健专业人员，支持进度评估以评估治疗计划 适当性，并可能对健康状况产生积极影响(包括疼痛水平和疼痛相关能力)。 然而，人们对通常做法中建议使用的PROMS的翻译程度知之甚少 脊椎按摩师。本提案中研究的目标是描述在LBP中使用经过验证的PROM 在退伍军人健康管理局(VHA)脊椎诊所进行管理，并进行可行性试点测试 护理点CDS警报，以便于在文档工作流程中使用。技术的改编 接受模型将被用作增加脊医通过以下方式使用PROM的理论基础 一种以技术为基础的干预。在目标1中，我们将量化当前经验证的国家文件 VHA脊椎按摩师在LBP护理过程中使用电子健康记录的自然语言处理 数据。在目标2中，我们将向VHA脊医进行调查，以了解 用于胎膜早破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产品的接受度、可用性和适当性 以健康记录为基础的临床决策支持警报作为促进胎膜早破使用的干预措施。在《目标3》中，我们将 在四个VHA脊椎疗法中进行开发的CDS警报的单臂可行性和可接受性试点 评估初步干预措施的采用率、可行性和可接受性作为结果。建议数 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，包括临床医生将胎膜早破作为一种 质量标记，以及脊椎疗法诊所和其他共同管理的护理环境中的患者结果 伦敦金融城。作为一项职业发展奖提案，这个项目将为科尔曼博士的职业生涯做好准备 独立科学家并为未来的试验提供信息，研究使用护理点决策支持工具来指导 LBP管理。他已经组建了一支由不同医学专业知识的导师和合作者组成的团队 信息学、临床研究、脊椎按摩护理和干预发展，以指导他向 独立调查员。在这个导师奖期间，他将获得和提高他在 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.