Musculoskeletal Diagnoses Cohort: Examining Pain and Pain Care in the VA

描述（由申请人提供）： 在退伍军人事务部（VA），治疗退伍军人与肌肉骨骼诊断（MSD），一组疾病，包括背部和颈部问题，骨关节炎，神经压迫，以及其他炎症和退行性疾病，长期以来一直在初级保健环境中管理。这一观察结果与疼痛管理的阶梯式护理模式（SCM-PM）一致，该模式是VA疼痛护理的单一标准，并声称大多数常见的疼痛状况应在初级保健环境中由患者对齐护理团队进行管理。然而，对患有MSD的退伍军人的特征，疼痛的发展和持续性，与医疗和心理健康共病的相关性，疼痛管理的可变性以及各种治疗的结果和成本知之甚少。需要这些数据来确定疼痛护理的变化和差距，从而为质量改进工作提供信息。 对于拟议的项目，我们将使用现有的国家VA电子临床和管理数据创建一个纵向队列的退伍军人与MSD在VA护理。这些数据将用于表征接受VA护理的MSD退伍军人，并检查疼痛，疼痛治疗，合并症的影响和结局的变化，包括患者和设施特征的成本。数据的解释和使用将由慢性病护理模型提供信息，该模型为该项目提供了总体框架。MSD队列将作为基础临床信息系统，以了解和告知促进输送系统和卫生系统组织变革的努力，与正在进行的VA转型努力一致，以鼓励以退伍军人为中心的护理和SCM-PM的实施。 我们的具体目标是：1）识别患有MSD的退伍军人，并描述他们的社会人口统计学和临床特征，疼痛筛查的变化，疼痛的严重程度和持续性; MSD发作的持续时间和复发; 2）评估治疗和结局的变化，包括治疗类型（包括阿片类药物）的差异，以及开始治疗的时间，通过 患者和机构特征;心理健康服务对疼痛报告和共病的影响 抑郁症;和不良事件及其预测因子;和3）通过患者和设施特征以及临床特征（例如，具体的MSD、合并症和持续时间），并且由与COT相关的不良事件引起。 我们来自几个VA HSR & D中心的经验丰富的研究人员团队的初步工作，以及我们的患者护理服务和运营合作伙伴的支持，将有助于快速创建完整的队列。该项目的早期交付将是一个综合数据库，可以满足这些群体的分析需求。该队列旨在通过提供经过验证的算法来为其他CREATE项目提供信息，以促进使用VA电子健康记录数据来识别医疗服务利用率，合并症的存在，阿片类药物的接受和疼痛筛查结果，以及其他护理方面，随着时间的推移。我们将共享构建变量的代码，或通过与现有数据集合并来共享数据。该项目将提供有关疼痛管理的重要数据，以直接支持国家疼痛管理项目办公室和我们其他合作伙伴的战略计划。特别重要的是，通过我们与分析和商业智能办公室的合作，该项目有机会在VHA疼痛管理绩效指标的开发中发挥关键作用。

DESCRIPTION (provided by applicant): In the Department of Veterans Affairs (VA), treatment for Veterans with musculoskeletal diagnoses (MSD), a cluster of disorders including back and neck problems, osteoarthritis, nerve compression, and other inflammatory and degenerative disorders, has long been managed in the primary care setting. This observation is consistent with the Stepped Care Model of Pain Management (SCM-PM) that is the VA's single standard for pain care and that asserts that most common pain conditions should be managed in the Primary Care setting by Patient Aligned Care Teams. Yet, little is known about the characteristics of Veterans with MSD, the development and persistence of pain, associations with medical and mental health comorbidities, variability in pain management, and outcomes and costs of various treatments. These data are needed in order to identify variation and gaps in pain care that can inform quality improvement efforts. For the proposed project, we will create a longitudinal cohort of Veterans with MSD in VA care using existing national VA electronic clinical and administrative data. These data will be used to characterize Veterans with MSD receiving VA care, and examine variation in pain, pain treatment, effects of comorbidities, and outcomes, including costs by patient and facility characteristics. Interpretation and use of the data will be informed by the Chronic Care Model which provides an overarching framework for this project. The MSD cohort will serve as a foundational Clinical Information System to understand and inform efforts to promote Delivery Systems and Health System Organizational Change consistent with ongoing VA transformational efforts to encourage Veteran- centered care and implementation of the SCM-PM. Our specific aims are to: 1) Identify Veterans with MSD and describe their socio-demographic and clinical characteristics, variation in pain screening, severity and persistence of pain; duration and recurrence of MSD episodes; 2) Assess variation in treatment and outcomes, including disparities in types of treatment (including opioids), and time to initiate treatment, by patient and facility characteristics; effect of mental health services on pain reports and comorbid depression; and adverse events, and their predictors, associated with chronic opioid therapy (COT); and 3) Estimate the costs of MSD care, by patient and facility characteristics, and by clinical characteristics (e.g., specific MSD, comorbidities, and duration), and resulting from adverse events associated with COT. Preliminary work by our experienced team of investigators from several VA HSR&D Centers, in addition to support from our patient care services and operations partners, will facilitate rapid creation of the full cohort. An early deliverable of this project will be a comprehensive database that can serve the analytic needs of these groups. The cohort is designed to inform other CREATE projects by providing validated algorithms to facilitate use of VA electronic health record data to identify health services utilization, presence of comorbid conditions, receipt of opioid medications, and pain screening results, among other dimensions of care, over time. We will share codes for constructing variables, or share data through merges with our existing datasets. The project will provide important data on pain management to directly support the strategic plan of the National Pain Management Program Office and our other partners. Of particular importance is the opportunity for this project to play a key role in the development of pain management performance measures for VHA through our collaboration with the Office of Analytics and Business Intelligence.