Administrative Supplement for: Improving Access to Chiropractic Care for Low Back Pain in Underserved Primary Care Settings: Development and Evaluation of a Multi-level Implementation Strategy

行政补充：改善服务不足的初级保健机构中腰痛脊椎按摩治疗的可及性：制定和评估多层次实施策略

• 批准号: 10400293
• 负责人: Eric J Roseen
• 金额: $ 3.72万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10400293
• 关键词: Acupuncture Therapy; Acute; Address; Administrative Supplement; Administrator; Adult; Affect; American College of Physicians; Analgesics; Anthropology; Applications Grants; Award; Back Pain; Benefits and Risks; Biometry; Boston; Caring; Chronic low back pain; Clinic; Clinical; Clinical Practice Guideline; Clinical Research; Clinical Sciences; Clinical Trials; Collaborations; Communities; Development; Development Plans; Doctor of Chiropractic; Documentation; Education; Educational workshop; Effectiveness; Environment; Epidemiology; Evaluation; Failure; Focus Groups; Funding; Future; Goals; Grant; Group Interviews; Guidelines; Health; Health Services; Health Services Research; Health system; Hybrids; Improve Access; Income; Institutes; Interview; K-Series Research Career Programs; Low Back Pain; Low income; Maps; Massachusetts; Massage; Measurement; Measures; Medical; Medical center; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Minnesota; Minority Groups; Modeling; Musculoskeletal; Neighborhood Health Center; Neighborhoods; Opioid; Outcome; Pain management; Patients; Pattern; Pharmaceutical Preparations; Pharmacology; Policies; Policy Maker; Population Heterogeneity; Pragmatic clinical trial; Primary Health Care; Process; Provider; Publishing; Qualitative Methods; Randomized; Research; Research Personnel; Research Project Grants; Research Training; Resources; Scientist; Self Care; Services; Site; Spinal Manipulation; Statistical Data Interpretation; Statistical Models; Structure; Training; Training Activity; Training Programs; Translational Research; Underserved Population; United States; Universities; Writing; base; care providers; career; career development; chiropracty; clinical epidemiology; cost; design; disability; effectiveness evaluation; effectiveness outcome; effectiveness study; effectiveness trial; ethnic disparity; evidence base; experience; implementation outcomes; implementation research; implementation science; implementation strategy; implementation trial; improved; innovation; non-opioid analgesic; pain patient; pragmatic trial; prescription opioid; primary care setting; primary outcome; racial disparity; racial diversity; recruit; research and development; responsible research conduct; skills; socioeconomic disparity; systematic review; underserved community; uptake; working group

PROJECT SUMMARY Background: Low back pain (LBP) is common, disabling and costly. Recent American College of Physicians guidelines recommend nonpharmacologic treatments (e.g., spinal manipulation, heat, massage, and acupuncture) as safe and effective first-line approaches for LBP. However, these treatments are most commonly provided to middle- to high- income predominantly white communities, with limited access for low income racially-diverse patients. Chiropractic care, which includes spinal manipulation, is a prototypical example of this care gap; few doctors of chiropractic (DCs) are integrated into medical settings, and primary care providers (PCPs) rarely refer to community-based DCs. Goals and Objectives: Dr. Roseen’s long-term career objective is to become an independent investigator studying the effectiveness and implementation of LBP treatments for underserved populations. This K23 career development award will allow Dr. Roseen to gain advanced skills in conducting pragmatic clinical trials that can assess the real-world effectiveness of LBP treatments and to become competent in the development and assessment of implementation strategies. Career Development Activities: The K23 application will provide structured didactic and hands-on training that will build on Dr. Roseen’s training in chiropractic and epidemiology, through experience and education in process mapping, qualitative methods, implementation strategies, outcome measurement in pragmatic trials, and advanced statistical analyses. The plan will engage Dr. Roseen in robust training activities including mentorship, coursework, research projects, publishing and presenting, workshops and seminars, grant-writing, and responsible conduct of research. Mentors: Dr. Roseen’s mentorship team consists of accomplished scientists from clinical research, health services research, epidemiology, biostatistics, medical anthropology, implementation science, and primary care. Environment: Dr. Roseen will benefit from a comprehensive research training program based at Boston University (BU), Boston Medical Center, BU Clinical Epidemiology Research and Training Unit, BU Center for Improvement and Implementation Science, and BU Clinical and Translational Science Institute. Research: Dr. Roseen’s proposed K23 research project will address the limited availability of nonpharmacologic treatments, using chiropractic care as an exemplar, in primary care settings. Dr. Roseen will first engage key stakeholders through process mapping and analysis (Aim 1a). Secondly, qualitative methods will be used to identify facilitators and barriers of PCP-DC referrals (Aim 1b). He will then design and pilot a multi-level implementation strategy in three community health centers based in underserved neighborhoods in Boston (Aim 2). This award will prepare Dr. Roseen to submit a future competitive grant application for a multi-site hybrid implementation and effectiveness trial of chiropractic care for LBP in underserved communities.

项目概要 背景：腰痛 (LBP) 很常见、致残且费用昂贵。 指南推荐非药物治疗（例如脊柱推拿、热敷、按摩和 针灸）是治疗 LBP 的安全有效的一线方法。 通常提供给以白人为主的中高收入社区，低收入群体获得的机会有限 脊椎按摩治疗（包括脊柱推拿）是一种典型的治疗方式。 这种护理差距的例子；很少有脊椎按摩医生（DC）融入医疗机构和初级保健机构 护理提供者 (PCP) 很少提及社区 DC 的目标和目标：Rosen 博士的长期目标。 职业目标是成为一名独立调查员，研究以下各项的有效性和实施情况 Roseen 博士将获得针对服务不足人群的 LBP 治疗。 进行实用临床试验的先进技能，可以评估 LBP 在现实世界中的有效性 治疗并有能力制定和评估实施战略。 职业发展活动：K23 应用程序将提供结构化的教学和实践培训， 将通过 Roseen 博士在脊椎按摩疗法和流行病学方面的培训为基础，通过以下方面的经验和教育 流程图、定性方法、实施策略、实用试验中的结果衡量、 该计划将使罗森博士参与强有力的培训活动，包括 指导、课程作业、研究项目、出版和演示、讲习班和研讨会、拨款写作、 负责任的研究行为：罗森博士的导师团队由经验丰富的人组成。 来自临床研究、卫生服务研究、流行病学、生物统计学、医学人类学的科学家， 实施科学和初级保健：罗森博士将受益于全面的。 波士顿大学 (BU)、波士顿医学中心、BU 临床流行病学研究培训项目 研究和培训单位、BU 改进和实施科学中心、BU 临床和 转化科学研究所：Rosen 博士提出的 K23 研究项目将解决有限的问题 以脊椎按摩疗法为例，在初级保健机构中提供非药物治疗。 Roseen 博士将首先通过流程图和分析吸引关键利益相关者参与（目标 1a）。其次， 将使用定性方法来确定 PCP-DC 转诊的促进因素和障碍（目标 1b）。 在服务欠缺地区的三个社区卫生中心设计并试点多层次实施战略 该奖项将为 Roseen 博士提交未来的竞争性资助做好准备。 申请对 LBP 进行脊椎按摩治疗的多地点混合实施和有效性试验 服务不足的社区。