Identifying and Promoting Quality Low Back Pain Care by Chiropractors

识别并促进脊椎按摩师提供优质的腰痛护理

• 批准号: 10672977
• 负责人: Brian Christopher Coleman
• 金额: $ 14.37万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672977
• 关键词: Adoption; Affect; Award; Caring; Chiropractor; Clinic; Clinical; Clinical Informatics; Clinical Practice Guideline; Clinical Research; Clinical effectiveness; Communication; Communities; Complementary Health; Consultations; Data; Development; Diagnosis; Direct Costs; Documentation; Electronic Health Record; Electronics; Elements; Facilities and Administrative Costs; Foundations; Funding; Future; Goals; Guidelines; Health; Health Care Costs; Health Professional; Health Status; Integrated Health Care Systems; Integrative Medicine; Intervention; Investigation; K-Series Research Career Programs; Knowledge; Life; Low Back Pain; Measures; Medical Informatics; Mentors; Methodology; Methods; Modeling; Musculoskeletal Pain; Natural Language Processing; Outcome; Outcome Measure; Pain; Pain Measurement; Pain intensity; Pain management; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pattern; Perception; Pilot Projects; Population; Pragmatic clinical trial; Prevalence; Questionnaires; Recommendation; Research; Research Personnel; Sampling; Scientist; Standardization; Surveys; System; Technology; Text; Training; Translations; Veterans Health Administration; Visit; Work; acceptability and feasibility; arm; care delivery; career; chiropracty; clinical decision support; clinical encounter; clinical implementation; clinical practice; cost effectiveness; data mining; disability; effectiveness evaluation; experience; implementation science; improved; pilot test; point of care; pragmatic trial; programs; remediation; shared decision making; skills; standardize measure; structured data; support tools; therapy development; treatment planning; treatment trial; usability; week trial

Abstract High-quality low back pain (LBP) care should include nonpharmacological interventions as the primary management strategy and serial pain assessment using validated patient reported outcome measures (PROMs). PROMs are standardized, validated questionnaires completed by patients to identify and quantify their perceptions of their health status. In addition to serving as a marker of high-quality LBP care, PROM use may impact pain-related clinical practice by facilitating shared decision making and communication between patients and healthcare professionals, enabling progress assessment to evaluate treatment plan appropriateness, and possibly positively influencing health status (including pain level and pain-related ability). However, little is known about the extent of translation of the recommended use of PROMs in usual practice by chiropractors. The goal of the research in this proposal is to describe the use of validated PROMs in LBP management in Veterans Health Administration (VHA) chiropractic clinics and perform feasibility pilot testing of a point-of-care CDS alert to facilitate use in the documentation workflow. An adaptation of the Technology Acceptance Model will be used as the theoretical basis for increasing use of PROMs by chiropractors through a technology-based intervention. In Aim 1, we will quantify the current national documentation of validated PROMs during LBP care by VHA chiropractors using natural language processing on electronic health record data. In Aim 2, we will survey VHA chiropractors to understand priorities and considerations in the documentation and clinical workflow for PROM use and clinical decision support. This “community-based” approach to stakeholder engagement will assess the acceptance, usability, and appropriateness of electronic health record based clinical decision support alert as an intervention to promote PROM use. In Aim 3, we will conduct a single-arm feasibility and acceptability pilot of the developed CDS alert in four VHA chiropractic clinics, measuring preliminary intervention adoption, feasibility, and acceptability as outcomes. The proposed research will evaluate the feasibility and refine methods in support of a full-scale pragmatic trial to assess the effects of a CDS alert intervention on high-quality LBP care delivery, including clinician use of PROMs as a quality marker, and on patient outcomes in chiropractic clinics and other care settings commonly managing LBP. As a career development award proposal, this project will prepare Dr. Coleman for a career as an independent scientist and inform future trials studying the use of point-of-care decision support tools to guide LBP management. He has assembled a team of mentors and collaborators with diverse expertise in medical informatics, clinical research, chiropractic care, and intervention development to guide his transition to an independent investigator. During this mentored award, he will acquire and enhance his knowledge and skills in clinical research, including pragmatic clinical trials and implementation science.

抽象的 高质量的下背痛（LBP）护理应包括非药物干预措施 使用经过验证的患者报告的结果指标的管理策略和串行疼痛评估 （舞会）。舞会是标准化的，经过验证的调查表，由患者完成，以识别和量化 他们对健康状况的看法。除了作为高质量LBP护理的标记外，舞会使用 通过支持共同的决策和交流之间的共同的决策和沟通 患者和医疗保健专业人员，使进度评估能够评估治疗计划 适当性，并可能积极影响健康状况（包括疼痛水平和与疼痛有关的能力）。 但是，关于在通常的实践中推荐使用舞会的翻译程度知之甚少 脊医。该提案中研究的目的是描述在LBP中使用经过验证的舞会的使用 退伍军人卫生管理局（VHA）脊椎治疗诊所的管理，并进行可行性试点测试 CAR Point CD的警报可促进文档工作流程中的使用。技术的改编 接受模型将被用作通过脊医通过通过的理论基础 基于技术的干预措施。在AIM 1中，我们将量化当前已经过验证的国家文件 VHA脊医在LBP护理期间使用电子健康记录上的自然语言处理的舞会 数据。在AIM 2中，我们将调查VHA脊医，以了解 舞会使用和临床决策支持的文档和临床工作流程。这个“基于社区” 利益相关者参与的方法将评估电子的接受，可用性和适当性 基于健康记录的临床决策支持警报是促进舞会使用的干预措施。在AIM 3中，我们将 在四个VHA脊骨疗法中进行发达CD的单臂可行性和可接受性飞行员 诊所，测量初步干预，可行性和可接受性作为结果。提议 研究将评估可行性和完善方法，以支持全面的务实试验来评估 CD警报干预对高质量LBP护理提供的影响，包括将PROM用作临床用途 质量标记，以及脊椎治疗诊所和其他护理环境中的患者预后 LBP。作为职业发展奖提案，该项目将为科尔曼博士准备职业做好准备 独立科学家并告知未来的试验，研究了使用即时保健决策支持工具的使用 LBP管理。他已经与Divers Medical专家组成了一组导师和合作者 信息信息，临床研究，脊椎治疗和干预开发，以指导他过渡到 独立研究者。在此事项奖励期间，他将获得并增强他的知识和技能 临床研究，包括务实的临床试验和实施科学。