Addressing Disparities In Pain Management

解决疼痛管理方面的差异

基本信息

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
项目类别：
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&apos 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

项目摘要

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：疼痛治疗方面的差异表明，有色人种退伍军人和女性退伍军人（即“多样化”）越来越多的证据表明，本 CDA 中的“退伍军人”在寻求疼痛护理时受到不平等待遇。指出符合指南、基于证据的非药物疼痛治疗的重要性（NPT）用于治疗慢性疼痛，但这些治疗方法并未惠及不同的退伍军人。实施映射可用于严格规划基于证据的实践的实施（例如，使用这种方法，可以确定实施循证的主要障碍和促进因素。实践并将其映射到相关策略实施和目标用户。本 CDA 的目的是：制定并测试量身定制的实施蓝图，以增加不同退伍军人对《不扩散核武器条约》的使用。意义/影响：在接下来的四十年里，超过 200 万退伍军人患有慢性疼痛。预计有色人种的数量将呈指数级增长，并且女性之间的种族/民族异质性要大得多迫切需要确定可用于以下方面的有效实施策略：传播 NPT，以满足未来患有慢性疼痛的不同退伍军人的需求。创新：该提案提供了三项创新：1）绘制关键健康状况的综合概念框架 2）使用开发的实施蓝图全面且严格的实施前规划方法（即实施映射）通过与目标用户的混合方法研究获得信息；3) 高度关注健康公平和包容性；在研究的每个阶段，通过运营伙伴关系让不同的退伍军人参与。具体目标： 1) 目标 1：了解并确定推动不同退伍军人使用 NPT 的因素混合方法；子目标 1.1：确定不同退伍军人在使用 NPT 的情况下未使用 NPT 的地点子目标 1.2：评估设计方案所需的多层次利益相关者的观点为不同退伍军人量身定制的实施蓝图；评估退伍军人管理局使用 NPT 的差异； 2) 目标 2：利用实施映射来识别 NPT 的核心和非核心组成部分采纳并设计适合不同退伍军人的实施蓝图；子目标 2.1：生成矩阵；使用量身定制的实施蓝图所产生的变革成果；制定协议；以及构成定制蓝图实施的材料；以及 3) 目标 3：衡量实施前的情况目标 2 中制定的定制蓝图的结果，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。方法：在目标 1.1 中，使用 VA 管理的定量抽样策略将告知选择在目标 1.2 中，定性访谈将确定推动不同国家使用《不扩散核武器条约》的因素。退伍军人，反过来，将在目标 1.3 定量中告知患者和组织因素的选择在目标 2.1 中，我们将使用实施映射并综合目标 1 的结果来开发一个需求评估并设计实施蓝图在目标 2.2 中，我们将开发蓝图协议和材料包括面向患者和提供者的实施策略，促进“推动”的理念（例如，学术细节）和“拉动”（例如，直接面向患者的外展）在目标 3 中，实施蓝图将在提供者和不同的退伍军人之间进行评估，以评估实施前结果的可接受性，使用评估调查和访谈评估可行性、适当性、剂量和复杂性。后续步骤/实施：这些发现将为两个 HSR&D 研究者发起的开发提供信息值得注意的是，这种方法可以为 CDA 的第 3 年和第 5 年提交的研究（IIR）提案提供信息。未来在退伍军人管理局和其他卫生系统中实施循证护理。