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

项目摘要/摘要： 对处方阿片类药物的依赖是一种公共健康危机，影响着美国数百万人-证据- 基于临床的指导对于控制疼痛同时降低阿片类药物使用障碍(OUD)的风险至关重要，但是 在处理与腹腔镜术(包括机器人)相关的急性疼痛方面缺乏指导。 外科手术是大量腹部外科手术的首选技术，而且还在不断增长。 胆囊切除、肠梗阻、阑尾切除、结肠和直肠手术等)。项目，管理 腹腔镜术后围手术期疼痛：一种合作开发、传播和 评估循证实践(M-PALS Collaborative)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合作，然后翻译和评估该CPG 练习一下。我们假设这一最新和全面的中央人民政府和随后的实施和 传播将导致更好的疼痛管理和最大限度减少阿片类药物的使用，以及减少 腹腔镜术后OUD的发生率(特别是在服用鸦片的幼稚患者中)，并且有类似的改善 患者满意度和疼痛管理指标。考虑到不同地区的可变性和 手术工作流程通过实践设置，我们通过在M Health开展工作来确保广泛的适用性 Fairview(UMN，由UMN医学院、MN医师大学和Fairview Health合作 服务)和加州大学旧金山分校，覆盖了不同和多样化的患者群体。目标 1：与FDA合作，在MN-EPC的指导下，开发出一种腹腔镜式手术疼痛 管理总干事。我们将利用和扩展国家科学院、工程院和 关于急性疼痛管理的医学(NASEM)框架，召集多学科专家利益攸关方，以及 指导CPG发展以应对腹腔镜术人群和对非MET的前景 需求，包括疼痛管理方面的差异。目标2：落实和宣传中央人民政府。核心活动 涵盖CPG接受、学术传播、网站材料、LHS学习社区 增强/扩展，通过阶梯式楔形设计实施EHR工具CPG(包括CDS)，以及 EHR-供应商临床计划，以在组织之间共享工具。目标3：评估和评估中央人民政府 包括采用、对促进者和障碍的反馈以及结果。评估初级(CPG依从性、疼痛 评分、阿片类药物使用)和RE-AIM指导的次要结果；评估实施情况(例如，研究 战略、系统因素、利益相关者参与)由EPIS指导。这个项目意义重大，具有创新性， 可行，应用严格的CPG开发，扩展NASEM报告框架，使用新的LHS 实施CPG的方法，并利用一支具有以下记录的跨学科专家团队 成功的协作和卫生系统-嵌入式研究。

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.