Hybrid Effectiveness-Implementation Trial of Guided Relaxation and Acupuncture for Chronic Sickle Cell Disease Pain

在美国，每天有近100人死于处方阿片类药物过量。过度依赖 对这些慢性疼痛的阿片类药物是导致这场危机的因素之一。急性和慢性疼痛， 这是如此严重，它需要阿片类药物试图保持在可容忍的水平，是一个恒定的伴侣， 美国有10万人，大多数是非洲或西班牙裔背景，全世界还有数百万人 镰状细胞病（SCD）疼痛是SCD的标志性症状，也是几乎所有SCD的主要原因。 每年有20万例急诊（艾德）入院，是住院的主要原因， 据估计，美国每年的医疗保健费用为24亿美元。我们将进行混合1型有效性 实施试验，以评估针灸和引导放松对360名SCD患者的有效性 同时观察和收集三个卫生系统的实施信息：伊利诺伊大学 医院与健康科学系统、佛罗里达大学健康中心和杜克大学健康系统。每个 为大量SCD患者提供服务，使用EPIC作为他们的电子健康记录，并提供临床和 转化科学奖（CTSA），这将有助于加快将发现转化为改善患者 在乎UG 3 1年规划阶段：第1年包括里程碑驱动的规划， 用于后续实用临床试验（UH 3）的系统。在UH 3实施阶段，我们的3臂、3- 临床试验机构随机对照试验将遵循定量SMART设计。一个务实的审判， 适应性干预，我们的指导放松和针灸干预措施对患者的 特征和不断变化的疼痛状态。我们依靠实施研究综合框架 （CFIR）计划、执行和评估相关的实施过程。使用互补和 综合（CIH）疗法，以减少疼痛，阿片类药物的使用，使自己更好地 科普他们的疼痛是众所周知的，但很少有研究评估这些疗法的有效性， 也没有一个评估跨多个医疗保健系统和患者人群的实施情况 就像这项研究一样。

Nearly 100 people die every day from a prescription opioid overdose in the United States (US). Over-reliance on opioids for these with chronic pain is one of the factors that led to this crisis. Pain, both acute and chronic, that is so severe that it requires opioids to attempt to keep to tolerable levels, is a constant companion to the 100,000 people in the United States, mostly of African or Hispanic background, and millions more worldwide living with sickle cell disease (SCD). Pain is SCD’s hallmark symptom, and the leading cause for almost 200,000 annual emergency department (ED) admissions, and is the leading cause of hospitalization, with estimated annual health care costs in the US of $2.4 billion. We will conduct a hybrid type 1 effectiveness implementation trial to assess the effectiveness of acupuncture and guided relaxation on 360 people with SCD while observing and gathering information on implementation in three health systems: University of Illinois Hospital & Health Sciences System, University of Florida Health, and Duke University Health Systems. Each serves a large population with SCD, uses EPIC as their electronic health record, and has a Clinical and Translational Science Award (CTSA), which will help speed the translation of discovery into improved patient care. UG3 1-year Planning Phase: Year 1 comprises milestone-driven planning to prepare the three health systems for the subsequent pragmatic clinical trial (UH3). During the UH3 Implementation Phase, our 3-arm, 3- site randomized controlled trial will follow a quantitative SMART design. A pragmatic trial that evaluates adaptive interventions where our guided relaxation and acupuncture interventions responds to patients’ characteristics and evolving pain status. We rely on the Consolidated Framework for Implementation Research (CFIR) to plan, execute, and evaluate associated implementation processes. The use of complementary and integrative (CIH) therapies by those with SCD to reduce pain, opioid use, and enable themselves to better cope with their pain is well known, but there are few studies that evaluate the effectiveness of these therapies, and none that also evaluates the implementation across multiple health care systems and patient populations as this study will.