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 9/11后退伍军人的一半最终最终会因肌肉骨骼疾病而获得连接的残疾。 这些退伍军人经常继续发展慢性疼痛，并处于滥用物质的高风险。早期的 干预，将退伍军人连接到多模式疼痛治疗，对于退伍军人过渡至关重要 军事从事平民医疗保健，以逮捕恶化的疼痛，并启动或加剧风险使用物质的使用。 筛查，简短的干预和转诊疼痛管理治疗（SBIRT-PM）已显示为 为此目的有用；以及9/11后军事2VA（M2VA）计划中的案件经理非常完美 定位以交付它。 M2VA计划在每个VA医疗中心，并被指控协调VA 所有与军方分离的服务成员的医疗保健。 M2VA的SBIRT-PM实施 可能需要便利，因为提供案件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特定培训，并且不是通常的 为这项工作提供了设施的支持，该努力需要跨疼痛治疗方式和系统进行协调。 在与M2VA计划的国家领导下合作，我们提出了一个随机的2-圆形群集， 2型混合试验以测试实施的有效性，成本效益和患者级别的效果 SBIRT-PM的促进策略。按1年计划阶段告知，我们将随机分配28 VA 医疗中心至两个条件之一。在实验条件下的站点中的M2VA案例经理将 接受SBIRT-PM的培训，然后进行实施便利化（案例查找报告，咨询小组， 审计和反馈，技术援助以及解决问题的支持）由外部便利化提供 团队（具有痛苦，成瘾，病例管理和实施科学专业知识）和内部促进者 在每个医疗中心。关系协调框架将指导促进工作。比较站点 将接受SBIRT-PM训练与单身。试验之前，期间和之后的形成性评估 告知实施促进策略以最适合该项目的调整。从完整的队列中 寻求肌肉骨骼疾病服务连接的退伍军人，我们将招募并关注1848年 退伍军人在入学后3和9个月进行基线时进行了更详细的电话评估。我们假设 增加实施促进的训练 - 对SBIRT-PM的训练将导致更高的比例 接受SBIRT-PM（触及）的退伍军人，参加培训和使用的案件经理比例更高 Sbirt-PM至少三名退伍军人（收养），并更好地遵守SBIRT-PM协议 （执行）。我们进一步假设实施促进SBIRT-PM将改善退伍军人 临床结局（疼痛，风险使用）并增加非药物疼痛治疗的数量 用过的。我们将确定实施促进的成本效益和预算影响相对于 训练与与SBIRT-PM接触退伍军人并改善其临床结果。