Reaching Rural Veterans: Applying Mind-Body Skills for Pain Using a Whole Health Telehealth Intervention (RAMP-WH)

接触农村退伍军人：通过整体健康远程医疗干预运用身心技能来缓解疼痛 (RAMP-WH)

• 批准号: 10738693
• 负责人: Diana J Burgess
• 金额: $ 127.41万
• 依托单位: CENTER FOR VETERANS RESEARCH AND EDUCATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738693
• 关键词: Address; Adherence; Adoption; Affect; Ambulatory Care Facilities; Awareness; Behavioral; Biophysics; Caring; Chronic; Cognitive; Collaborations; Communities; Complementary Health; Complex; Data Collection; Decision Making; Drug Monitoring; Drug Prescriptions; Education; Enrollment; Ensure; Equity; Evidence based intervention; Exercise; Female; Future; Health system; Healthcare; Healthcare Systems; Hybrids; Integrated Health Care Systems; Integrative Medicine; Intervention; Investments; Knowledge; Learning; Mental Health; Methods; Mindfulness Training; Minority; Modeling; Opioid; Organization and Administration; Outcome; Pain; Pain interference; Pain management; Participant; Patient-Centered Care; Patients; Personal Satisfaction; Phase; Pilot Projects; Practical Robust Implementation and Sustainability Model; Pragmatic clinical trial; Ramp; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Resources; Rural; Rural Health; Safety; Sampling; Self Management; Site; Social Conditions; Substance abuse problem; System; Veterans; Woman; Work; budget impact; care systems; chronic pain; chronic pain management; chronic pain patient; community partnership; comorbidity; design; effectiveness outcome; effectiveness testing; ethnic minority; evidence base; experience; health administration; implementation barriers; implementation intervention; implementation strategy; implementation/effectiveness; improved; innovation; medical specialties; military veteran; mind/body; mindfulness; minority patient; multidisciplinary; non-opioid analgesic; novel; opioid use; pain reduction; prevent; primary outcome; programs; psychologic; racial minority; randomized trial; recruit; relative effectiveness; rural America; rural area; rural patients; rural residence; scale up; secondary outcome; skills; skills training; social; telehealth; treatment as usual; whole health

1 This project addresses the significant challenge of implementing effective, non-opioid interventions for chronic pain 2 management in rural and remote dwelling Veteran populations. Pain is a complex biophysical, psychological, and social 3 (BPS) condition and there is a growing evidence base to support several complementary and integrative health (CIH) 4 approaches, which can address pain in a more holistic way. While the VA has become a leader in advancing CIH through 5 its Whole Health Initiative, there remain many barriers, especially for rural patients. Our team has co-developed, with 6 multiple-levels of VA stakeholders (including rural patients), an innovative telehealth evidence-based intervention that 7 builds upon our team's previous research. The Reaching Rural Veterans: Applying Mind-Body Skills for Pain Using a 8 Whole Health Telehealth Intervention (RAMP-WH) project strategically coalesces multiple evidence based CIH self- 9 management strategies to address Veterans' BPS needs and overcome existing barriers. Comprised of pain education, 10 mindfulness, pain specific exercises, and cognitive behavioral strategies, the program is cohesive and scalable. Designed 11 to be implemented within the VA through its nationwide Whole Health System initiative, it uses VA Whole Health (WH) 12 coaches as program facilitators. RAMP-WH is a 12-week program including a 1-to-1 session with a WH Coach, followed 13 by 11 group sessions including pre-recorded expert led education videos, mind-body skill training and practice, and 14 facilitated discussions. For the preparatory phase (UG3) we will conduct 1) stakeholder engagement activities including 15 identifying and developing new community partnerships and using mixed methods data collection from multiple levels of 16 stakeholders (n=35-50 patients, community partners, VA healthcare system leaders and staff), guided by the established 17 RE-AIM/PRISM framework, to learn about key factors that can affect long-term adoption; and 2) conduct a pilot study of 18 40 rural VA patients with chronic pain to assess the feasibility of delivering RAMP-WH (experimental intervention for 19 the UH3 trial) in terms of recruitment and engagement, intervention fidelity and adherence, data collection, and other key 20 metrics. For the UH3 Phase, we will conduct a randomized hybrid type 2 effectiveness-implementation multi-site 21 pragmatic clinical trial of RAMP-WH compared to Usual Care, among rural patients (n=500) in the VA healthcare 22 system. UH3 Aim 1 will assess the relative effectiveness of RAMP-WH in terms of the primary effectiveness outcome 23 of pain interference at 13 and 26 weeks and secondary outcomes including opioid use and other HEAL recommended 24 outcomes. In UH3 Aim 2 we will work iteratively with multiple levels of stakeholders (from UG3) to evaluate 25 intervention implementation strategies used in the trial and adapt these strategies to scale up RAMP-WH within the 26 national VA healthcare system. This will include: a) conducting mixed-methods assessments of stakeholder and 27 randomized trial participant views of implementation-related barriers and facilitators, resource needs, and other RE- 28 AIM/PRISM domains; b) working with stakeholders to co-create additional plausible strategies for overcoming barriers to 29 implementation of RAMP-WH; and c) conducting budget impact analyses using models informed by stakeholder views to 30 inform future decision making. 31

1该项目解决了对慢性疼痛实施有效的非阿片类药物干预的重大挑战 2.农村和偏远地区的退伍军人管理。疼痛是一个复杂的生物物理，心理和社会 3（BPS）的条件，有越来越多的证据基础，以支持几个补充和综合健康（CIH） 4种方法，可以以更全面的方式解决疼痛。虽然退伍军人事务部已成为推动CIH通过 5其整体健康倡议，仍然存在许多障碍，特别是对农村患者。我们的团队共同开发， 6个多层次的VA利益相关者（包括农村患者），这是一种创新的远程医疗循证干预措施， 7是基于我们团队以前的研究。到达农村退伍军人：应用身心技能的疼痛使用 8全健康远程医疗干预（RAMP-WH）项目战略性地结合了基于CIH自我- 9项管理战略，以解决退伍军人的BPS需求和克服现有的障碍。包括疼痛教育， 10正念，疼痛特定的练习，和认知行为策略，该计划是有凝聚力和可扩展的。设计 11将通过其全国性的全健康系统倡议在VA内实施，它使用VA全健康（WH） 12名教练作为项目主持人。RAMP-WH是一个为期12周的计划，包括与WH教练的1对1课程， 13至11组会议，包括预先录制的专家指导的教育视频，身心技能培训和实践，以及 14篇促进讨论在筹备阶段（UG3），我们将开展1）利益相关者参与活动，包括 15确定和发展新的社区伙伴关系，并使用混合方法从多个层面收集数据， 16名利益相关者（n = 35 - 50名患者、社区合作伙伴、VA医疗保健系统领导和工作人员），由既定的 17 RE-AIM/PRISM框架，以了解可能影响长期采用的关键因素;以及2）进行 18 40名患有慢性疼痛的农村VA患者，以评估提供RAMP-WH的可行性（ 19 UH3试验）在招募和参与、干预忠诚度和依从性、数据收集和其他关键方面， 20个指标。对于UH3阶段，我们将进行一项随机混合2型有效性-实施多中心研究 在VA医疗保健的农村患者（n = 500）中进行的21项RAMP-WH与家庭护理相比的实用临床试验 22系统。UH3目标1将评估RAMP-WH在主要有效性结局方面的相对有效性 第13周和第26周时的23例疼痛干预和次要结局，包括阿片类药物使用和其他HEAL建议 24个结果在UH3 Aim 2中，我们将与多个级别的利益相关者（来自UG 3）迭代合作以进行评估 试验中使用的25种干预实施策略，并调整这些策略，以在 26国家卫生系统这将包括：a）对利益攸关方进行混合方法评估， 27名随机试验参与者对实施相关障碍和促进因素、资源需求和其他可再生能源的看法 28个AIM/PRISM领域; B）与利益相关者合作，共同制定其他可行的战略，以克服 （c）利用基于利益攸关方意见的模型进行预算影响分析， 30为未来的决策提供信息。 31