Managing Perioperative Pain with Abdominal Laparoscopic Surgery: A Collaborative to Develop, Disseminate, and Evaluate Evidence-Based Practices (M-PALS Collaborative)

通过腹部腹腔镜手术管理围手术期疼痛：开发、传播和评估循证实践的合作组织 (M-PALS 合作组织)

• 批准号: 10907265
• 负责人: Mary E Butler
• 金额: $ 200万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-25 至 2026-09-24
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10907265
• 关键词: Managing; Perioperative; Pain; Abdominal; Laparoscopic

Project Summary/Abstract: Dependence on prescription opioids is a public health crisis affecting millions of people in the U.S. Evidence- based clinical guidance is critical for managing pain while reducing the risk of opioid use disorder (OUD), but there is a lack of guidance for managing acute pain associated with abdominal laparoscopic (including robotic) surgeries, which is the preferred and growing technique for a vast number of abdominal surgeries (e.g. cholecystectomy, bowel obstruction, appendectomy, colon and rectal surgery, etc.). The project, Managing Perioperative Pain After Abdominal Laparoscopic Surgery: A Collaborative to Develop, Disseminate, and Evaluate Evidence-Based Practices (M-PALS Collaborative) will develop a clinical-practice guideline (CPG) with interdisciplinary stakeholders and subject matter experts, and then translate and evaluate this CPG in practice. We hypothesize this up-to-date and comprehensive CPG and subsequent implementation and dissemination will result in superior pain management and minimized use of opioids, as well as decreased rates of OUD after abdominal laparoscopic surgery (especially in opiate naive patients), and similarly improved patient satisfaction and pain management metrics. To account for variability by region and differences in surgical workflow by practice setting, we ensure broad applicability by conducting our work at M Health Fairview (UMN, a collaboration of the UMN Medical School, Univ of MN Physicians, and Fairview Health Services) and the University of California, San Francisco across distinct and diverse patient populations. Aim 1: In collaboration with the FDA and guided by MN-EPC, develop a laparoscopic abdominal surgical pain management CPG. We will leverage and extend the National Academy of Sciences, Engineering, and Medicine (NASEM) framework on acute pain management, convene multidisciplinary expert stakeholders, and guide CPG development to address abdominal laparoscopic surgical populations and perspectives on unmet needs, including disparities in pain management. Aim 2: Implement and disseminate the CPG. Core activities cover CPG acceptance, academic dissemination, website materials, LHS learning communities to enhance/scale, EHR tool CPG implementation (including CDS) via a stepped-wedge design, and an EHR-vendor clinical program to share tools across organizations. Aim 3: Evaluate and assess the CPG including adoption, feedback on facilitators and barriers, and outcomes. Assess primary (CPG adherence, pain scores, opioid use) and secondary outcomes guided by RE-AIM; evaluate implementation (e.g., study strategies, system factors, stakeholder engagement) guided by EPIS. This project is significant, innovative, and feasible, applying rigorous CPG development, extending NASEM report frameworks, utilizing novel LHS approaches in CPG implementation, and leveraging a transdisciplinary expert team with a track record of successful collaboration and health system-embedded research.

项目概要/摘要： 对处方阿片类药物的依赖是影响美国数百万人的公共卫生危机。 基于临床的指导对于管理疼痛，同时降低阿片类药物使用障碍（OUD）的风险至关重要， 缺乏与腹腔镜（包括机器人）相关的急性疼痛管理指南 外科手术，这是用于大量腹部手术的优选和不断增长的技术（例如， 胆囊切除术、肠梗阻、阑尾切除术、结肠和直肠手术等）。项目，管理 腹部腹腔镜手术后的围手术期疼痛：一个合作的发展，传播， 评估循证实践（M-PALS协作）将制定临床实践指南（CPG） 与跨学科的利益相关者和主题专家，然后翻译和评估本CPG， 实践我们假设这个最新的和全面的CPG和随后的实施， 传播将导致上级疼痛管理和最小化阿片类药物的使用，以及减少 腹部腹腔镜手术后OUD的发生率（尤其是在未使用阿片类药物的患者中）， 患者满意度和疼痛管理指标。考虑到各区域的差异以及 手术工作流程的实践设置，我们确保广泛的适用性，通过开展我们的工作在M健康 Fairview（UMN，UMN医学院，明尼苏达大学医师和Fairview健康的合作 Services）和加州大学旧金山分校（University of San弗朗西斯科，San Francisco）在不同和多样化的患者人群中进行了研究。目的 1：与FDA合作，在MN-EPC的指导下，开发腹腔镜腹部手术疼痛 管理CPG。我们将利用和扩大国家科学院，工程， 医学（NASEM）急性疼痛管理框架，召集多学科专家利益相关者， 指导CPG开发，以解决腹部腹腔镜手术人群和未满足的前景 需求，包括疼痛管理的差异。目标2：执行和宣传《中央政府施政方针》。核心活动 涵盖CPG接受，学术传播，网站材料，LHS学习社区， 增强/规模，EHR工具CPG实施（包括CDS）通过阶梯楔形设计， EHR-供应商临床计划，以在组织间共享工具。目标3：评价和评估CPG 包括采用、对促进者和障碍的反馈以及结果。评估主要（CPG依从性、疼痛 评分，阿片类药物使用）和RE-AIM指导的次要结局;评估实施情况（例如，研究 战略、系统因素、利益相关者参与）。这个项目意义重大，具有创新性， 和可行的，应用严格的CPG开发，扩展NASEM报告框架，利用新的LHS 在CPG实施的方法，并利用跨学科的专家团队， 成功的合作和卫生系统内的研究。