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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要慢性疼痛会影响美国成年人群的20％以上，并且经常对质量产生令人沮丧的影响生活，身心功能。居住在农村社区的个人经历了更高的比率由于疼痛，慢性疼痛以及健康结果较差。住在农村的4600万美国人经常无法获得基于证据的非药物治疗慢性疼痛的地区。因此，存在批判性需求，以实施有效的，全面的疼痛管理计划，包括非 - 药理治疗方案。护士护理管理（NCM）已成功用于增强照顾患有其他慢性病或高风险并发症的人。使用2型混合有效性 - 实践设计，我们建议适应，试点和实施 NCM模型，包括护理协调，认知行为疗法（CBT）和转介到远程为慢性疼痛的农村患者提供运动计划。每个卫生系统将确定适当的医疗保健专业人员将接受护理经理的培训。对于CBT组件，护理经理将是经过培训，可以让患者参加远程交付的CBT计划。进行锻炼，我们将提供远程交付增强健身，这是一个基于证据的16周计划，包括有氧和力量训练锻炼。在UG3阶段，我们将与2个卫生系统的患者，临床医生和护理经理联系在学习协作中为农村患者提供服务，以试行NCM模型。此外，我们将适应基础架构和工作流程以实施干预计划，并让合作伙伴卫生系统开发与社区合作伙伴的关系并确定护理经理。在UH3阶段，我们将进行在慢性病患者中，改编的NCM模型的随机对照试验与通常的护理疼痛。我们已经从2个基于实践的研究网络，WWAMI（华盛顿，怀俄明州，阿拉斯加，蒙大拿州和爱达荷州）地区实践和研究网络以及梅克伦堡地区北卡罗来纳州农村的初级保健研究合作伙伴关系。我们的主要结果是疼痛干扰通过疼痛，享受生活和一般活动（PEG）量表来衡量。我们的次要结果包括身体功能，睡眠，疼痛灾难性，抑郁，焦虑，治疗满意度，使用物质疾病，止痛药物使用/剂量，包括阿片类药物和医疗保健利用。我们将探索是否差异通过按年龄，性别，种族/民族分析来检查治疗效果中的异质性，存在和健康保险。我们将使用RE-AIM框架评估实施结果和定性与一部分患者进行访谈，以评估干预经验。如果成功，这研究将对农村地区的慢性疼痛管理产生变革性影响通过创新的NCM模型，基于证据的非药物治疗。