AIM BACK UH3 Transition

瞄准回来 UH3 过渡

基本信息

批准号：
10581589
负责人：
STEVEN Z GEORGE
金额：
$ 158.09万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-20 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10581589
关键词：
Acute Address Adherence Agreement Arthritis Back Back Pain Behavior Therapy Behavioral Sciences Bioinformatics Biometry Caring Characteristics Chronic Chronic low back pain Clinical Clinical Practice Guideline Clinical Protocols Clinical Research Cluster randomized trial Computerized Patient Records Counseling Data Diagnostic tests Dimensions Doctor of Philosophy Effectiveness Electronic Health Record Enrollment Ensure Environment Exposure to Feedback Goals Health system Healthcare Systems Heterogeneity Home Image Improve Access Infrastructure Injections Institution Institutional Review Boards Internal Medicine Lead Leadership Low Back Pain Managed Care Managed Care Programs Massage Measures Medical Medical center Medicine Methods Mind Nonpharmacologic Therapy North Carolina Operative Surgical Procedures Opioid Outcome Pain Pain Research Pain interference Pain management Participant Pathway interactions Patient Care Patients Phase Physical Function Physical activity Physical therapy Policies Positioning Attribute Practice Guidelines Pragmatic clinical trial Procedures Provider Psychiatry Recommendation Reporting Research Research Design Research Institute Research Personnel Resources Risk Role Self Management Services Site Spinal Manipulation Structure Subgroup System Telephone Testing Training Transcutaneous Electric Nerve Stimulation United States Department of Veterans Affairs United States National Institutes of Health Universities Veterans Veterans Health Administration base biopsychosocial collaboratory comparative effectiveness comparative effectiveness trial compare effectiveness data management data sharing networks design disability effectiveness evaluation high risk improved integrated care member military veteran multimodality opioid exposure pain reduction pain relief pain score pharmacologic pilot test primary outcome programs psychologic public health relevance routine practice telephone delivery tool treatment effect treatment risk trial planning working group

项目摘要

ABSTRACT: Improving Veteran Access to Integrated Management of Chronic Back Pain LBP is among the most prevalent and disabling medical problems for Veterans. Improving patient care for LBP is a high priority for many federal agencies and recent clinical practice guidelines emphasize the importance of non-pharmacological management of LBP. However, optimal care pathways involving non-pharmacological treatments have not been established. Care pathways aligned with a “biopsychosocial” conceptualization of LBP are highly valued, but are rarely delivered in routine practice environments and still need to be investigated for their effectiveness. The overall goal of this UG3 (Planning Phase)/UH3 (Demonstration Project) proposal is to improve access to recommended non-pharmacologic therapies for LBP in the Department of VA Health Care System. In UG3 phase trial planning will be accomplished through two aims: 1) establish policies, procedures, and regulatory agreements for data management and resource sharing needs and 2) finalize research design and clinical protocols needed to conduct a high-quality, multi-center pragmatic cluster randomized trial. The pragmatic cluster randomized trial proposed for the UH3 Demonstration Project will compare the effectiveness of two LBP management approaches designed to enhance access to non- pharmacological pain treatments and biopsychosocial oriented care: a) sequenced, multi-modal integrated care pathway incorporating physical pain treatment, tailored behavioral treatment, and home base activity versus 2) care management by pain navigator program that facilitates coordinated use of existing VA or non- VA pain management resources. With clinical practice guidelines in mind, both pathways have been purposefully structured to include non-pharmacological pain modulation. Veterans enrolled in the trial (n = 1,250) will be followed for primary outcomes (PROMIS Short Form scores for pain interference and function) captured from the electronic health record and a subset (n = 630) will complete phone captured patient reported secondary augment electronic health record capture. In Aim 1 we will examine the effectiveness of a sequenced, multi-modal integrated care pathway for LBP, compared to a care management by pain navigator program. Our central hypothesis is that the multi-modal, integrated care pathway will reduce pain interference with normal activities and improve physical function compared with the care management program. In Aim 2 we will determine participant characteristics associated with greater improvements in pain interference and function, and better adherence to each care pathway. Aim 2 will inform the potential for matching Veteran subgroup characteristics to a specific care pathway that provides greater potential for improvement in pain and function. This proposal is directly aligned with primary goals of the NIH-DoD-VA Pain Management Collaboratory by aligning existing VA health system resources to expand capacity to deliver earlier non- pharmacological pain management for the Veteran with LBP.

摘要：改善退伍军人访问慢性背痛的综合管理 LBP是退伍军人最普遍，最禁用的医疗问题之一。改善LBP的患者护理对于许多联邦机构而言，这是高度优先事项，最近的临床实践指南强调了的重要性 LBP的非药理学管理。但是，涉及非药物的最佳护理途径尚未建立治疗。护理途径与“生物心理社会”的概念化一致 LBP受到高度重视，但很少在常规练习环境中交付，仍然需要调查了它们的有效性。这个UG3（计划阶段）/UH3的总体目标（演示项目）建议是提高对LBP推荐的非药物疗法的访问 VA卫生保健系统部。在UG3阶段试验计划中，将通过两个目标来完成：1）制定数据管理和资源共享需求的制定政策，程序和监管协议 2）最终确定需要进行高质量的多中心务实所需的研究设计和临床方案聚类随机试验。为UH3示范项目提出的务实群集随机试验将比较两种LBP管理方法的有效性，旨在增强对非访问药理学疼痛治疗和生物心理社会的护理：a）测序的多模式综合护理途径增加身体疼痛治疗，量身定制的行为治疗和家庭基础活动对2）疼痛导航器计划的护理管理，该计划有助于协调使用现有的VA或非 - VA疼痛管理资源。考虑到临床实践指南，这两种途径已经有目的的结构，包括非药物疼痛调节。参加试验的退伍军人（n = 主要结果将遵循1,250）（疼痛干扰和功能的Promis短形式得分）从电子健康记录和子集（n = 630）中捕获的手机将完成手机捕获的患者报告了二次增强电子健康记录捕获。在目标1中，我们将研究一个与疼痛导航器的护理管理相比，LBP测序的多模式集成护理途径程序。我们的中心假设是多模式的综合护理途径将减轻疼痛干扰与护理管理计划相比，通过正常活动并改善身体功能。在目标2中我们将确定与疼痛干扰更大改善相关的参与者特征功能，并更好地遵守每个护理途径。 AIM 2将告知与老兵相匹配的潜力特定护理途径的亚组特征，为改善疼痛和功能。该提议直接与NIH-DOD-VA疼痛管理的主要目标保持一致通过使现有VA卫生系统资源保持一致的协作，以扩大能力，以提供早期的非 - LBP的退伍军人的药理疼痛管理。