Improving Chicago Older Adult Opioid and Pain Management through Patient-Centered Clinical Decision Support and Project ECHOî (I-COPE)

项目总结 尽管45-85%的老年人(≥65岁)患有慢性疼痛，但几乎没有证据表明如何 有效地治疗他们的慢性疼痛。此外，被诊断为药物使用障碍的OAS人数 从2012年到2015年，吸食海洛因的美洲国家组织的比例增加了一倍多。尽管 在这些问题的范围内，疼痛在许多OAS中仍然没有得到充分的控制，而且很少有量身定做的 对患有阿片类药物使用障碍的OAS的干预(OUD)。AHRQ呼吁以患者为中心的临床决策 支持(PCCDS)战略是质量改进项目的核心，以解决安全有效的慢性疾病 疼痛管理、阿片类药物使用和OUD治疗。芝加哥医科大学(UCM)已将SAFE 将阿片类药物处方纳入电子病历和临床工作流程，提高了医生的认识水平， 感知的有用性，以及自我报告的指南-许多关键的疾控中心建议的一致性实践。 当存在以下不确定性时，共享决策(SDM)是一种高效的协作框架 最佳的治疗选择，这是OAS常见的疼痛情况。访问社区卫生服务 位于芝加哥大都市区的大型联邦合格卫生中心网络(Access)拥有 嵌入SDM作为他们评估患者目标和偏好的一部分。此外，UCM还有效地 使用了Echo项目，这是一个向社区传授亚专业医学知识的测试模型 提高城市医疗服务人员的自我效能感和实践行为 提供方，以及传播有关OUD的最佳做法。这项提案的目标是确定 是否开发和实施了解老年人情况的PCCDS-SDM工具包(改善芝加哥 通过PCCDS和Echo项目(I-COPE)对老年人进行阿片类药物和疼痛管理 管理慢性疼痛、慢性阿片类药物使用和OUD改善芝加哥最脆弱人群的临床结果 OAS。在目标1中，我们将使用以用户为中心的设计来创建i-cope程序。在目标2中，我们将评估 I-COPE计划在25个诊所的传播、实施和效果 阶梯形楔形设计。RE-AIM框架(REACH、有效性、采用、实施和 维护)将用于评估该计划。有了这些目标，这笔赠款将导致对 通过Project ECHO®传播的、基于EHR和SDM框架的PCCDS如何改进 慢性疼痛，阿片类药物和OUD在OAS。

PROJECT SUMMARY Even though 45-85% of older adults (age ≥65 years) suffer from chronic pain, little evidence exists for how to treat their chronic pain effectively. Furthermore, the number of OAs diagnosed with a substance use disorder has increased, and the proportion of OAs with heroin use has more than doubled from 2012-2015. Despite the scope of these problems, pain remains inadequately controlled in many OAs, and there are few tailored interventions for OAs with opioid use disorder (OUD). AHRQ has called for patient-centered clinical decision support (PCCDS) strategies to be central to quality improvement projects to address safe and effective chronic pain management, opioid use, and OUD treatment. University of Chicago Medicine (UCM) has integrated safe opioid prescribing into the EHR and clinical workflow, resulting in increased physician levels of awareness, perceived usefulness, and self-reported guideline-concordant practice of many key CDC recommendations. Shared decision making (SDM) is a highly effective collaborative framework when there is uncertainty about the optimal treatment choice, a scenario which commonly exists for OAs with pain. Access Community Health Network (ACCESS), a large Federally Qualified Health Center network in the Chicago metropolitan area, has embedded SDM as part of how they assess patient goals and preferences. In addition, UCM has effectively used Project ECHO, a tested model for delivery of subspecialized medical knowledge to community providers, to improve self-efficacy and practice behaviors in geriatrics competencies for urban medical providers, as well as disseminate best practices regarding OUD. The goal of this proposal is to determine whether development and implementation of a geriatric-informed PCCDS-SDM toolkit (Improving Chicago Older Adult Opioid and Pain Management through PCCDS and Project ECHO (I-COPE) Program) for managing chronic pain, chronic opioid use, and OUD improves clinical outcomes for Chicago's most vulnerable OAs. In Aim 1, we will use a user-centered design to create the I-COPE Program. In Aim 2, we will evaluate the dissemination, implementation, and effectiveness of the I-COPE Program across >25 clinic using a stepped wedge design. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) will be used to evaluate the program. With these aims, this grant will lead to an understanding of how and EHR-based PCCDS alongside an SDM framework, disseminated via Project ECHO®, can improve chronic pain, opioids and OUD in OAs.