Implementation Facilitation of Screening, Brief Intervention, and Referral to Treatment for Pain Management for Veterans Separating from Military Service

为退伍军人实施疼痛管理筛查、短暂干预和转诊治疗提供便利

• 批准号: 10592726
• 负责人: Steve Martino
• 金额: $ 67.45万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592726
• 关键词: Address; Adherence; Adoption; Affect; Alcohols; Biochemical; Caring; Case Management; Case Manager; Charge; Clinical; Cluster randomized trial; Collaborations; Consultations; Counseling; Early Intervention; Enrollment; Feedback; Fostering; Health Services Accessibility; Health Technology; Healthcare; Hybrids; Leadership; Location; Logistics; Maintenance; Managed Care; Managed Care Programs; Measures; Medical center; Methods; Military Personnel; Modality; Modeling; Musculoskeletal Diseases; Nurses; Occupations; Outcome; Pain; Pain management; Participant; Patients; Performance; Phase; Positioning Attribute; Problem Solving; Procedures; Process; Protocols documentation; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Services; Site; Social Workers; Specific qualifier value; Structure of nail of finger; System; Telephone; Training; Veterans; Veterans Health Administration; Woman; addiction; budget impact; care systems; case finding; chronic pain; cohort; cost effectiveness; disability; effectiveness testing; effectiveness/implementation trial; evidence base; experience; formative assessment; health care service; health equity; high risk; hybrid type 2 trial; implementation facilitation; implementation outcomes; implementation science; implementation strategy; improved; intervention cost; military service; motivational enhancement therapy; multimodality; post 9/11; prevent; programs; recruit; screening, brief intervention, referral, and treatment; secondary outcome; service member; substance misuse; substance use; telehealth; uptake

Project Summary Fully half of post-9/11 Veterans eventually receive service-connected disability for musculoskeletal disorder. These Veterans often go on to develop chronic pain and are at high risk for substance misuse. Early intervention, connecting Veterans to multimodal pain treatment, is important for Veterans transitioning from military to civilian healthcare to arrest worsening pain and the initiation or exacerbation of risky substance use. Screening, Brief Intervention and Referral to Treatment for Pain Management (SBIRT-PM) has been shown to be useful for this purpose; and case managers in the Post-9/11 Military2VA (M2VA) program are perfectly positioned to deliver it. M2VA Programs are at each VA medical center and are charged with coordinating VA health care for all service members separating from the military. The implementation of SBIRT-PM by M2VA likely requires facilitation because the social workers and nurses who provide case management are not otherwise directed to specific training in multimodal pain care or addiction services, and they are not routinely provided facility support for this effort that requires coordination across pain treatment modalities and systems. In collaboration with the national leadership of the M2VA program, we propose a 2-cohort, cluster randomized, type 2 hybrid trial to test the effectiveness, cost effectiveness and patient-level effects of an implementation facilitation strategy for SBIRT-PM. Informed by a 1-year planning phase, we will randomly assign 28 VA medical centers to one of two conditions. M2VA case managers in sites within the experimental condition will receive training in SBIRT-PM followed by implementation facilitation (case finding report, consultation groups, audit and feedback, and technical assistance and problem-solving support) delivered by an external facilitation team (with pain, addiction, case management, and implementation science expertise) and internal facilitators at each medical center. A Relational Coordination framework will guide facilitation efforts. Comparator sites will receive SBIRT-PM training-as-usual. A formative evaluation before, during, and after the trial will iteratively inform the adjustment of the implementation facilitation strategy to best fit this project. From the full cohort of Veterans who are seeking service-connection for musculoskeletal disorders, we will recruit and follow 1848 Veterans for more detailed phone assessments at baseline, 3 and 9 months after enrollment. We hypothesize that adding implementation facilitation to training-as-usual for SBIRT-PM will result in a higher proportion of Veterans who receive SBIRT-PM (Reach), higher proportion of case managers who attend training and use SBIRT-PM with at least three Veterans (Adoption), and better adherence to the SBIRT-PM protocol (Implementation). We further hypothesize that implementation facilitation of SBIRT-PM will improve Veterans clinical outcomes (pain, risky substance use) and increase the number of non-pharmacological pain treatments used. We will determine the cost-effectiveness and budget impact of implementation facilitation relative to training-as-usual to reach Veterans with SBIRT-PM and improve their clinical outcomes.

项目概要 9/11 事件后的退伍军人中有整整一半最终因肌肉骨骼疾病而患有与服务相关的残疾。 这些退伍军人经常会出现慢性疼痛，并且滥用药物的风险很高。早期的 将退伍军人与多模式疼痛治疗联系起来的干预对于退伍军人从 军队到平民的医疗保健，以阻止日益恶化的疼痛以及开始或加剧危险药物的使用。 筛查、简短干预和转介疼痛管理治疗 (SBIRT-PM) 已被证明可以 对这个目的有用； 9/11 后 Military2VA (M2VA) 计划中的案例经理非常完美 定位于交付它。 M2VA 计划在每个 VA 医疗中心开展，负责协调 VA 为所有脱离军队的军人提供医疗保健。 M2VA 实施 SBIRT-PM 可能需要协助，因为提供病例管理的社会工作者和护士不是 否则针对多模式疼痛护理或成瘾服务的具体培训，并且它们不是常规的 为这项需要跨疼痛治疗方式和系统进行协调的努力提供了设施支持。 与 M2VA 计划的国家领导层合作，我们提出了一个 2 队列、整群随机、 2 类混合试验，用于测试实施的有效性、成本效益和患者层面的影响 SBIRT-PM 的促进策略。根据 1 年规划阶段，我们将随机分配 28 VA 医疗中心符合以下两种情况之一。实验条件下地点的 M2VA 案例管理人员将 接受 SBIRT-PM 培训，然后进行实施促进（案例发现报告、咨询小组、 审计和反馈、技术援助和问题解决支持）由外部协助提供 团队（具有疼痛、成瘾、案例管理和实施科学专业知识）和内部协调员 在每个医疗中心。关系协调框架将指导便利化工作。比较站点 将照常接受 SBIRT-PM 培训。试验前、试验期间和试验后的形成性评估将反复进行 通知调整实施促进战略以最适合该项目。从整个队列中 正在寻求肌肉骨骼疾病服务联系的退伍军人，我们将招募并关注 1848 退伍军人在基线、注册后 3 个月和 9 个月进行更详细的电话评估。我们假设 在 SBIRT-PM 的常规培训中增加实施便利将导致更高比例的 接受 SBIRT-PM (Reach) 的退伍军人，参加培训和使用的案例经理比例更高 SBIRT-PM 至少有三名退伍军人（收养），并且更好地遵守 SBIRT-PM 协议 （执行）。我们进一步假设 SBIRT-PM 的实施便利将改善退伍军人 临床结果（疼痛、危险物质使用）并增加非药物疼痛治疗的数量 用过的。我们将确定实施便利化的成本效益和预算影响 像往常一样进行培训，以通过 SBIRT-PM 接触退伍军人并改善他们的临床结果。