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.

项目摘要 整整一半的9/11后退伍军人最终因肌肉骨骼疾病而接受与服务有关的残疾。 这些退伍军人经常继续发展慢性疼痛，并处于药物滥用的高风险之中。早期 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 从军事到民用医疗保健，以阻止疼痛恶化和危险物质使用的开始或加剧。 筛选，短暂干预和转诊治疗疼痛管理（SBIRT-PM）已被证明， 在后9/11军事2 VA（M2 VA）计划中的案例管理员是完美的 M2 VA计划在每个VA医疗中心，负责协调VA 为所有退伍军人提供医疗保健。SBIRT-PM的M2 VA实现 可能需要促进，因为提供病例管理的社会工作者和护士不是 另外，他们还接受了多模式疼痛护理或成瘾服务方面的具体培训，而且他们并不经常 为这一需要协调疼痛治疗方式和系统的努力提供了设施支持。 与M2 VA计划的国家领导层合作，我们提出了一个2队列，随机分组， 2型混合试验，以测试实施的有效性、成本效益和患者水平的影响 SBIRT-PM的促进战略。根据1年规划阶段的信息，我们将随机分配28名VA 医疗中心有两种情况。实验条件下研究中心的M2 VA病例管理员将 接受SBIRT-PM培训，然后促进实施（案例调查报告，咨询小组， 审计和反馈，以及技术援助和解决问题的支持） 团队（具有疼痛、成瘾、病例管理和实施科学专业知识）和内部促进者 每个医疗中心。一个关系协调框架将指导便利化工作。比较地点 将接受SBIRT-PM培训。试验前、试验中和试验后的形成性评估将反复进行 为调整执行促进战略提供信息，使其最适合本项目。从整个队列的 退伍军人谁正在寻求服务连接肌肉骨骼疾病，我们将招募和遵循1848 退伍军人在基线、入组后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， 接受SBIRT-PM（Reach）的退伍军人，参加培训和使用的案例经理比例较高 SBIRT-PM至少有三名退伍军人（收养），并更好地遵守SBIRT-PM方案 （执行）。我们进一步假设，SBIRT-PM的实施促进将改善退伍军人 临床结局（疼痛、危险物质使用），并增加非药物疼痛治疗的数量 采用我们将确定实施便利的成本效益和预算影响， 照常培训，以达到退伍军人与SBIRT-PM和改善他们的临床结果。