Addressing Disparities In Pain Management

解决疼痛管理方面的差异

• 批准号: 10642345
• 负责人: Sarah Javier
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10642345
• 关键词: Academic Detailing; Address; Adoption; Affect; Area; Automobile Driving; Belief; Biological; Caring; Cessation of life; Chronic; Clinic; Color; Data; Decision Aid; Dedications; Development; Disparity; Dose; Education; Ethnic Origin; Evaluation; Evidence based practice; Funding; Future; Gender; Goals; Guidelines; Health system; Heterogeneity; Hospitalization; Individual; Inequity; Interview; Investigator-Initiated Research; Logistic Regressions; Maps; Measures; Mentorship; Methodology; Methods; Monitor; Needs Assessment; Opioid; Outcome; Pain; Pain management; Patient Selection; Patients; Pharmacological Treatment; Population; Protocols documentation; Provider; Race; Reporting; Research; Research Methodology; Research Personnel; Research Proposals; Resources; Sampling; Self Efficacy; Site; Skin; Source; Surveys; Testing; Training; Treatment Protocols; Veterans; Woman; Women' s Health; access disparities; addiction; chronic pain; chronic pain management; data warehouse; debilitating pain; empowerment; evidence base; experience; future implementation; gender difference; health equity; implementation design; implementation facilitators; implementation outcomes; implementation science; implementation strategy; innovation; marginalized population; men; military veteran; non-cancer chronic pain; opioid epidemic; opioid therapy; outreach; patient outreach; psychologic; racial bias; social; stakeholder perspectives; stem; uptake; whole health

Background: Disparities in pain treatment suggest that Veterans of color and women Veterans (i.e., “diverse Veterans” in this CDA) are subject to unequal treatment when seeking pain care at VA. Mounting evidence points to the importance of guideline-concordant, evidence-based non-pharmacological pain treatments (NPTs) in the management of chronic pain, yet these treatments are not reaching diverse Veterans. Implementation mapping can be used to rigorously plan implementation of evidence-based practices (e.g., NPTs). Using this approach, one can identify key barriers and facilitators to implementation of evidence-based practices and map them to relevant implementation strategies and target users. The purpose of this CDA is to develop and test a tailored implementation blueprint for increasing NPT use among diverse Veterans. Significance/Impact: Over 2 million Veterans suffer from chronic pain. Over the next four decades, Veterans of color are projected to grow exponentially and there is far more racial/ethnic heterogeneity among women than men in the VA. There is a critical need to identify effective implementation strategies that can be used to disseminate NPTs in order to meet the needs of future diverse Veterans with chronic pain. Innovation: This proposal offers three innovations: 1) An integrated conceptual framework mapping key health equity domains to implementation science solutions; 2) An implementation blueprint developed using a comprehensive and rigorous pre-implementation planning approach (i.e., implementation mapping) that is informed by mixed methods research with target users; and 3) a strong focus on health equity and inclusion of diverse Veteran engagement via operational partnerships during each stage of research. Specific Aims: 1) Aim 1: Understand and identify factors driving NPT use among diverse Veterans using mixed methods; Sub-Aim 1.1: Identify sites at which diverse Veterans are not using NPTs despite NPTs being available; Sub-Aim 1.2: Evaluate multi-level stakeholder perspectives necessary for designing an implementation blueprint tailored for diverse Veterans; Sub-Aim 1.3: Assess disparities in NPT use in VA administrative data; 2) Aim 2: Use implementation mapping to identify core and non-core components of NPT uptake and design an implementation blueprint tailored for diverse Veterans; Sub-Aim 2.1: Generate a matrix of change outcomes resulting from use of a tailored implementation blueprint; Sub-Aim 2.2: Develop protocols and materials comprising the tailored implementation blueprint; and 3) Aim 3: Measure pre-implementation outcomes of the tailored blueprint developed in Aim 2, including feasibility, acceptability, appropriateness, dose, complexity, and self-efficacy among target users. Methodology: In Aim 1.1, a quantitative sampling strategy using VA administrative will inform the selection of four implementation sites. In Aim 1.2, qualitative interviews will identify factors driving NPT use among diverse Veterans, which will, in turn, inform the selection of patient and organizational factors in Aim 1.3 quantitative analyses. In Aim 2.1, we will use implementation mapping and synthesize findings from Aim 1 to develop a needs assessment and design an implementation blueprint. In Aim 2.2, we will develop blueprint protocols and materials comprising patient- and provider-facing implementation strategies that promote the ideas of “push” (e.g., academic detailing) and “pull” (e.g., direct-to-patient outreach) In Aim 3, the implementation blueprint will be assessed among providers and diverse Veterans for pre-implementation outcomes of acceptability, feasibility, appropriateness, dose, and complexity using evaluation surveys and interviews. Next Steps/Implementation: These findings will inform the development of two HSR&D investigator-initiated research (IIR) proposals to be submitted in Years 3 and 5 of the CDA. Notably, this approach can inform the future implementation of evidence-based care across VA and other health systems.

背景：疼痛治疗中的差异表明，颜色和妇女退伍军人的退伍军人（即“多样化） 在此CDA中的退伍军人”在弗吉尼亚州寻求疼痛护理时受到不平等的治疗。 指出指导条件的重要性，基于证据的非药物疼痛治疗 （NPT）在慢性疼痛的管理中，但是这些治疗方法没有吸引潜水员。 实施映射可用于严格计划基于循证实践的实施（例如， NPT）。使用这种方法，可以将关键障碍和促进者识别为实施循证 实践并将其映射到相关的实施策略和目标用户。此CDA的目的是 开发和测试量身定制的实施蓝图，以增加潜水员的NPT使用。 显着性/影响力：超过200万退伍军人患有慢性疼痛。在接下来的四十年中，退伍军人 预计颜色将成倍增长，女性的种族/种族异质性更大 比弗吉尼亚州的男人。迫切需要确定可以用来用于的有效实施策略 为了满足患有慢性疼痛的未来潜水员退伍军人的需求。 创新：该提案提供了三个创新：1）集成的概念框架映射密钥健康 实施科学解决方案的权益领域； 2）实现蓝图使用 全面而严格的实施前计划方法（即实施映射） 通过与目标用户进行混合方法研究的知识； 3）强烈关注健康平等和包容 在研究的每个阶段，通过运营伙伴关系通过运营伙伴关系进行多样化的参与。 具体目的：1）目标1：了解并确定使用使用R. 混合方法； Sub-aim 1.1：识别潜水员不使用NPTS目的地NPT的网站 可用的; Sub-aim 1.2：评估设计设计所必需的多层次利益相关者观点 为多元化退伍军人量身定制的实施蓝图； Sub-aim 1.3：评估VA中NPT使用的差异 行政数据； 2）目标2：使用实施映射来识别不应该存的核心和非核心组件 吸收和设计为潜水退伍军人量身定制的实施蓝图； Sub-aim 2.1：生成一个矩阵 使用量身定制的实现蓝图产生的变化结果； Sub-aim 2.2：制定协议 以及完成量身定制的实施蓝图的材料； 3）目标3：测量实验前 在AIM 2中开发了量身定制的蓝图的结果，包括可行性，可接受性，适当性， 目标用户的剂量，复杂性和自我效能感。 方法：在AIM 1.1中，使用VA行政的定量抽样策略将告知选择的选择 四个实施站点。在AIM 1.2中，定性访谈将确定推动潜水员之间不应该存的因素 退伍军人，这将依次为AIM中的患者和组织因素选择1.3定量 分析。在AIM 2.1中，我们将使用AIM 1的实施映射并合成发现来开发一个 需要评估和设计实施蓝图。在AIM 2.2中，我们将开发蓝图协议，并 材料完成患者和面向提供者的实施策略，以促进“推动”思想 （例如，学术细节）和“拉力”（例如，直接到患者的外展）在AIM 3中，实施蓝图将 在提供者和潜水退伍军人之间进行评估，以实现可接受的预测结果， 使用评估调查和访谈的可行性，适当性，剂量和复杂性。 下一步/实施：这些发现将为两名HSR＆D调查员的开发提供信息 研究（IIR）的建议将在CDA的第3年和第5年中提交。值得注意的是，这种方法可以告知 跨VA和其他卫生系统的未来实施基于证据的护理。