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1/2 IMPACt-LBP CCC-Administrative Supplements for Complementary Health Practitioner Research Experience

1/2 IMPACt-LBP CCC-补充健康从业者研究经验的行政补充

基本信息

批准号：
10856432
负责人：
Adam Goode
金额：
$ 5.82万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-15 至 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10856432
关键词：
Administrative Supplement Adult Age Ambulatory Care American American College of Physicians Caring Categories Chronic low back pain Client satisfaction Clinic Clinical Clinical Research Clinical Trials Design Cluster randomized trial Collaborations Complementary Health Data Coordinating Center Doctor of Chiropractic Documentation Drug Prescriptions Emergency department visit Exercise Focus Groups Goals Guidelines Health Care Costs Health system Healthcare Systems Hospitalization Infrastructure Injections Intervention Interview Iowa Low Back Pain Measures Medical Medical Care Costs Medical center Methods Modeling Musculoskeletal Operative Surgical Procedures Opioid Organizational Policy Pain Pain interference Pain management Pain quality Patient Care Patients Phase Physical Function Physicians Policies Primary Care Procedures Protocols documentation Provider Quality-Adjusted Life Years Randomized, Controlled Trials Recommendation Reporting Research Research Design Research Institute Resources Risk Site Source Spinal Fusion Spinal Manipulation Standardization Surveys Symptoms System Testing Time Training Universities Visit Work chronic pain clinical pain clinical research site clinical trial protocol collaborative care comparative effectiveness compare effectiveness cost disability effectiveness testing experience functional status future implementation health care service utilization health service use implementation facilitation implementation trial improved incremental cost-effectiveness informant member multidisciplinary opioid epidemic opioid mortality opioid use pain reduction pain-related disability physical therapist pragmatic study prescription opioid primary care provider primary endpoint primary outcome process evaluation randomized, clinical trials secondary outcome service utilization treatment as usual uptake

项目摘要

Low back pain (LBP) is a key source of medical costs and disability, impacting over 31 million Americans at any given time and resulting in $100-$200 billion per year in total healthcare costs. LBP is one of the leading causes of ambulatory care visits to US physicians; unfortunately, these visits often result in treatments such as opioids that can lead to more harm than benefit. In 2017 the American College of Physicians (ACP) guideline for LBP recommended patients receive non-pharmacological interventions as a first-line treatment but stopped short of offering solutions regarding how such treatments should be integrated into routine patient care. Roadmaps exist for multi-disciplinary collaborative care that includes doctors of chiropractic and physical therapists, well-trained primary contact clinicians with specific expertise in the treatment of musculoskeletal conditions, as first line providers for LBP. These clinicians routinely employ many of the non-pharmacological approaches recommended by the ACP guideline, including spinal manipulation and exercise. Important foundational work conducted by members of the study team has demonstrated that such care is feasible, safe, and results in improved physical function, less pain, fewer opioid prescriptions, and reduced utilization of healthcare services. However, this treatment approach for LBP has yet to be widely implemented or validated using rigorous scientific methods. Our overarching goal is to refine and implement a multidisciplinary collaborative care model for LBP (MC2LBP) in 3 academic Health Care Systems (HCS) and then evaluate its effectiveness by comparing it to usual medical care in patients age 18 and older suffering from LBP. Completion of project study aims will begin with a one-year UG3 planning phase involving completion of 22 milestones in 2 categories of phased activities - model implementation and clinical trial design. UH3 study aims will be accomplished using a pragmatic, cluster-randomized, clinical trial design. The study will be managed through a Clinical Coordinating Center and Data Coordinating Center, both housed at the Duke Clinical Research Institute, in collaboration with Dartmouth-Hitchcock Medical Center and the University of Iowa. During the planning phase, we will build implementation infrastructure across three HCS, finalize the clinical trial protocol, and complete the tasks necessary to transition from the UG3 to UH3 phase. The UH3 phase will be used to: 1) Operationalize the integration of new organizational policies and procedures required to facilitate implementation of MC2LBP at intervention clinics; 2) Determine the comparative effectiveness of MC2LBP vs usual care; 3) Estimate and compare medical resource use and costs of implementing MC2LBP; and 4) Evaluate patient, provider, system and policy level barriers and facilitators to implementing MC2LBP, using a mixed method, process evaluation approach. Results from this study have the potential to inform future implementation and policy efforts to improve the quality of pain management for patients suffering from LBP while simultaneously reducing opioid prescriptions, health care costs and utilization of services.

腰痛（LBP）是医疗费用和残疾的主要来源，每年影响超过3100万美国人