STORM Implementation Program Evaluation

STORM实施计划评估

• 批准号: 9568349
• 负责人: Walid F. Gellad
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9568349
• 关键词: Accidents; Achievement; Acupuncture Therapy; Address; Adherence; Adverse event; Clinical; Clinical Data; Clinical Management; Collaborations; Data; Effectiveness; Equilibrium; Evaluation; Event; Guidelines; Health; Health Services Research; Healthcare Systems; Interview; Learning; Medical center; Mental Health; Methodology; Naloxone; Opioid; Outcome; Overdose; Pain; Pain management; Patients; Physical therapy; Policies; Program Evaluation; Randomized; Research; Research Personnel; Resources; Risk; Risk Estimate; Risk Factors; Risk Management; Safety; Services; Specific qualifier value; Stratification; Structure; Suicide; Surveys; Techniques; Testing; Translating; Uncertainty; Update; Variant; Veterans; Work; adverse outcome; arm; clinical risk; dashboard; design; evidence base; health equity; high risk; implementation research; implementation strategy; improved; individual patient; innovation; insight; non-opioid analgesic; operation; opioid therapy; predictive modeling; prescription opioid; programs; research and development; risk mitigation; tool; uptake

Background and significance: To mitigate the risks of adverse outcomes of opioid therapy, the VA Office of Mental Health Operations (OMHO) and the National Pain Management Program developed a tool to estimate and display the risk of adverse outcomes among patients prescribed opioids. Known as the Stratification Tool for Opioid Risk Management (STORM), the data dashboard displays individual patients’ level of risk, specific clinical risk factors, use of recommended risk mitigation strategies, and pain treatments. STORM is available for use by the field, but there is uncertainty about how to achieve consistent utilization across VA Medical Centers (VAMCs) and maximize its effectiveness in reducing opioid-related adverse events. The overall objective of this service-directed project is to perform, in collaboration with OMHO and the Partnered Evidence-Based Policy Resource Center (PEPReC), a randomized program evaluation that will allow the VA to randomize VAMCs to different STORM rollout conditions using a stepped-wedge design. This innovative feature will allow the VA to evaluate the impact of different rollout conditions on STORM uptake and clinical impact. Methodology and expected results: All VAMCs will receive a policy memorandum mandating STORM-facilitated case reviews of patients at high risk for opioid-related adverse events. VAMCS will be randomized to a policy that has consequences for not meeting target case review completion rates versus a policy without consequences. Subsequently, facilities will be randomized to perform case reviews on patients at the top 1% versus 5% of STORM risk scores in a stepped-wedge fashion. In this partnered evaluation, PEPReC will use VA administrative and clinical data to examine the effects of the randomized rollout on patient-level clinical outcomes. In parallel, a team of investigators from the Center for Health Research and Promotion (CHERP) will conduct facility-level quantitative and qualitative analyses to identify strategies used to implement STORM-facilitated case reviews across VAMCs nationally, as well as implementation barriers and facilitators at a subset of facilities. The CHERP evaluation consists of two overall aims. Aim 1a is to describe the number and type of strategies VAMCs used to implement the STORM policy and compare implementation strategies across the consequences and no consequences rollout arms. Aim 1b is to examine whether the number and type of STORM implementation strategies used by VAMCs predict achievement of the target case-review completion rate outlined in the STORM policy. These Aims will be achieved by conducting an online survey of implementation strategies used across all VAMCs. Regression techniques will be used to compare the number and types of strategies across rollout arms (Aim 1a) and examine their associations with case review completion rates (Aim 1b). Aim 2 is to identify barriers and facilitators to implementing the STORM policy and compare these barriers and facilitators across facilities in each STORM rollout arm. This will be achieved by interviewing key stakeholders at 40 VAMCs nationally using structured interview questions guided by the Consolidated Framework for Implementation Research. This randomized program evaluation provides a unique opportunity to identify the effect of STORM rollout variations and implementation strategies on STORM utilization and outcomes. The evaluation led by CHERP will yield critical insights that will enable OMHO and VA to refine policy implementation, and, synergistic with PEPReC’s evaluation, increase STORM’s clinical impact in accordance with VA priorities for a learning healthcare system.

背景和意义：为了降低阿片类药物治疗不良后果的风险，VA 办公室 心理健康行动 (OMHO) 和国家疼痛管理计划开发了一种工具来估计 并显示服用阿片类药物的患者出现不良后果的风险，称为分层工具。 对于阿片类药物风险管理 (STORM)，数据仪表板显示个体患者的风险水平、具体风险水平 可以使用临床风险因素、使用推荐的风险缓解策略和 STORM 治疗。 供现场使用，但如何在 VA Medical 实现一致使用尚不确定 中心 (VAMC) 并最大限度地发挥其减少阿片类药物相关不良事件的有效性。 这个以服务为导向的项目的总体目标是与 OMHO 和 合作循证政策资源中心 (PEPReC)，这是一项随机计划评估，将允许 VA 使用阶梯楔形设计将 VAMC 随机化到不同的 STORM 推出条件。 创新功能将使 VA 能够评估不同推出条件对 STORM 吸收的影响 方法和预期结果：所有 VAMC 将收到一份政策备忘录授权。 STORM 将对阿片类药物相关不良事件高风险患者进行病例审查。 随机分配到一项政策，该政策会因未达到目标案件审查完成率而产生后果 随后，机构将随机对患者进行病例审查。 在此次合作评估中，STORM 风险评分分别位于前 1% 和 5%。 PEPReC 将使用 VA 管理和临床数据来检查随机推出对 与此同时，来自健康研究中心的一组研究人员和 推广（CHERP）将进行设施级定量和定性分析，以确定所使用的策略 在全国 VAMC 中实施 STORM 促进的案例审查，并消除实施障碍 以及部分设施的协调员。 CHERP 评估由两个总体目标组成，目标 1a 是描述策略的数量和类型。 VAMC 用于实施 STORM 政策并比较各个国家的实施策略 后果和无后果推出武器的目的 1b 是检查是否有数量和类型。 VAMC 使用的 STORM 实施策略预测目标案例审查的完成情况 STORM 政策中概述的目标将通过进行在线调查来实现。 所有 VAMC 中使用的实施策略将用于比较数量。 以及跨推广部门的策略类型（目标 1a），并检查它们与案例审查的关联 完成率（目标 1b）是确定实施 STORM 政策的障碍和促进因素。 比较每个 STORM 部署部门中设施的这些障碍和促进因素 这将通过以下方式实现。 使用由 VAMC 指导的结构化访谈问题对全国 40 个 VAMC 的主要利益相关者进行访谈 实施研究综合框架。 此随机计划评估提供了一个独特的机会来确定 STORM 推出的效果 CHERP 主导的 STORM 利用和结果的变化和实施策略。 将产生重要的见解，使 OMHO 和 VA 能够完善政策实施，并发挥协同作用 通过 PEPReC 的评估，根据 VA 的学习优先事项提高 STORM 的临床影响 医疗保健系统。