Adapting and Implementing a Nurse Care Management Model to Care for Rural Patients with Chronic Pain

适应和实施护理管理模式来护理农村慢性疼痛患者

• 批准号: 10741606
• 负责人: Kushang Patel
• 金额: $ 154.56万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-18 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10741606
• 关键词: Address; Adult; Aerobic Exercise; Affect; Age; Alaska; American; Analgesics; Anxiety; Area; Behavior; Caring; Case Manager; Chronic; Cognitive Therapy; Communities; Counseling; Data; Disparity; Education; Ethnic Origin; Exercise; Gender; Geography; Goals; Health Insurance; Health Professional; Health Services Accessibility; Health system; Healthcare Systems; Heterogeneity; Household; Idaho; Income; Individual; Infrastructure; Insurance Coverage; Intervention; Interview; Learning; Life; Measures; Mental Depression; Mental Health; Modeling; Montana; North Carolina; Nursing Care Management; Opioid; Outcome; Outcome Measure; Pain; Pain intensity; Pain interference; Pain management; Patients; Pattern; Phase; Physical Function; Population; Primary Care; Process; Quality of life; Race; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Resources; Rural; Rural Community; Services; Sleep; Sleep disturbances; Social Functioning; Subgroup; Substance Use Disorder; Testing; Training; United States; United States National Institutes of Health; Variant; Washington; Wyoming; biopsychosocial; care coordination; chronic pain; chronic pain management; chronic pain patient; collaboratory; comorbidity; daily functioning; disability; dosage; effectiveness evaluation; effectiveness/implementation design; evidence base; exercise program; experience; fitness; health care service; health care service utilization; high risk; implementation evaluation; implementation outcomes; improved; innovation; intervention program; mental function; opioid overdose; pain catastrophizing; patient engagement; patient subsets; pilot test; poor health outcome; post intervention; practice-based research network; primary outcome; programs; recruit; remote delivery; response; rural area; rural patients; rural residence; rurality; satisfaction; secondary outcome; strength training; treatment as usual; treatment effect

PROJECT SUMMARY Chronic pain affects over 20% of the U.S. adult population and frequently has debilitating effects on quality of life and physical and mental functioning. Individuals living in rural communities experience higher rates of chronic pain as well as poorer health outcomes because of pain. The 46 million Americans who live in rural areas frequently lack access to evidence-based, non-pharmacologic treatments for chronic pain. As such, a critical need exists to implement effective, comprehensive programs for pain management that include non- pharmacologic treatment options. Nurse care management (NCM) has been successfully used to enhance care for individuals with other chronic conditions or at high risk of complications. Using a type 2 hybrid effectiveness-implementation design, we propose to adapt, pilot, and implement a NCM model that includes care coordination, cognitive behavioral therapy (CBT), and referrals to a remotely delivered exercise program for rural patients with chronic pain. Each health system will identify appropriate health care professionals to be trained as care managers. For the CBT component, care managers will be trained to engage patients in a remotely delivered CBT program. For exercise, we will offer remotely delivered Enhance Fitness, which is an evidence-based, 16-week program that includes aerobic and strength training exercise. In the UG3 phase, we will engage patients, clinicians, and care managers from 2 health systems serving rural patients in a learning collaborative to pilot the NCM model. In addition, we will adapt infrastructure and workflows to implement the intervention program and engage the partnering health systems in developing relationships with community partners and identifying care managers. In the UH3 phase, we will conduct a randomized controlled trial of the adapted NCM model versus usual care in rural dwelling patients with chronic pain. We have recruited 6 health systems from 2 practice-based research networks, the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) region Practice and Research Network and the Mecklenburg Area Partnership for Primary Care Research in rural North Carolina. Our primary outcome is pain interference as measured by the Pain, Enjoyment of Life and General Activity (PEG) scale. Our secondary outcomes include physical function, sleep, pain catastrophizing, depression, anxiety, treatment satisfaction, substance use disorder, pain medication use/dosage including opioids, and health care utilization. We will explore if disparities exist by examining heterogeneity in treatment effects via subgroup analyses by age, gender, race/ethnicity, and health insurance. We will use the RE-AIM framework to assess implementation outcomes and qualitative interviews conducted with a subset of patients to evaluate experiences with the intervention. If successful, this study will have a transformative effect on chronic pain management in rural areas by expanding access to evidence-based, non-pharmacologic treatments through an innovative NCM model.

项目摘要 慢性疼痛影响超过20%的美国成年人口，并经常对质量产生削弱作用 生命和身体及精神功能。生活在农村社区的个人经历更高的 慢性疼痛以及由于疼痛而导致的健康状况较差。4600万生活在农村的美国人 这些地区经常缺乏对慢性疼痛的循证、非药物治疗。因此，一 迫切需要实施有效的，全面的疼痛管理计划，包括非 药物治疗选择。护士护理管理（NCM）已成功地用于提高 护理患有其他慢性病或并发症风险高的个人。 使用类型2混合有效性-实施设计，我们建议调整，试点和实施 NCM模式，包括护理协调，认知行为治疗（CBT）和远程转诊 为农村慢性疼痛患者提供锻炼计划。每个卫生系统将确定适当的 将保健专业人员培训为保健管理人员。对于CBT组件，护理经理将 接受培训，让患者参与远程交付的CBT计划。为了锻炼，我们将提供远程交付 增强健身，这是一个以证据为基础的16周计划，包括有氧和力量训练 锻炼的在UG 3阶段，我们将邀请来自2个卫生系统的患者、临床医生和护理经理参与 在学习合作中为农村患者服务，以试点NCM模式。此外，我们将调整基础设施 和工作流程，以实施干预计划，并使合作的卫生系统参与制定 与社区合作伙伴的关系和确定护理管理人员。在UH 3阶段，我们将进行 适应性NCM模式与常规护理在农村慢性病患者中的随机对照试验 痛苦我们从2个基于实践的研究网络，WWAMI（华盛顿， 怀俄明州、阿拉斯加州、蒙大拿州和爱达荷州）地区实践与研究网络和梅克伦堡地区 北卡罗来纳州农村初级保健研究伙伴关系。我们的主要结果是疼痛干扰， 通过疼痛、生活乐趣和一般活动（PEG）量表测量。我们的次要结果包括 身体功能，睡眠，疼痛灾难化，抑郁，焦虑，治疗满意度，物质使用 疾病、疼痛药物使用/剂量（包括阿片类药物）和医疗保健利用。我们将探讨差异是否 通过按年龄、性别、人种/种族进行亚组分析， 和健康保险。我们将使用RE-AIM框架来评估实施结果和定性 与一部分患者进行访谈，以评估干预的经验。如果成功，这 这项研究将通过扩大对农村地区慢性疼痛管理的获得， 通过创新的NCM模式进行循证的非药物治疗。