Complementary and Integrative Health Stepped Care for Co-occurring Chronic Pain and PTSD

针对同时发生的慢性疼痛和创伤后应激障碍 (PTSD) 的补充和综合健康阶梯护理

• 批准号: 10663398
• 负责人: David E Reed
• 金额: $ 8.59万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10663398
• 关键词: Adherence; Administrator; Affect; Alaska; Award; Back; Caring; Characteristics; Chronic; Chronic Post Traumatic Stress Disorder; Clinic; Clinical; Clinical Trials Design; Collaborations; Community Healthcare; Complementary Health; Complex; Data; Data Analyses; Dedications; Development; Diagnostic Factor; Ensure; Evaluation; Faculty; Feedback; Focus Groups; Foundations; Funding; Goals; Grant; Health system; Healthcare Systems; Human Subject Research; Idaho; Individual; Institution; Integrative Medicine; Intervention; Interview; Learning; Measurement; Measures; Mental Health; Mentors; Mentorship; Mind-Body Intervention; Modeling; Montana; National Center for Complementary and Integrative Health; Nonpharmacologic Therapy; Pain; Pain interference; Pain management; Participant; Pathway interactions; Patients; Personal Satisfaction; Phase; Positioning Attribute; Post-Traumatic Stress Disorders; Pragmatic clinical trial; Primary Care; Process; Provider; Randomized; Readiness; Recording of previous events; Research; Research Personnel; Resources; Rural; Site; Structure; Symptoms; System; Technology; Testing; Training; Treatment Protocols; Use Effectiveness; Visualization; Washington; Writing; Wyoming; career; career development; chronic pain; chronic pain management; chronic pain patient; design; dissemination science; early phase trial; evidence base; experience; implementation science; improved; interest; learning strategy; member; mind/body; mindfulness meditation; novel; novel strategies; opioid epidemic; pain outcome; patient population; patient response; physical conditioning; pilot test; pilot trial; pragmatic trial; primary care clinic; primary care setting; primary care team; professor; programs; prototype; randomized effectiveness trial; rumination; rural setting; satisfaction; treatment as usual; treatment planning; treatment response; treatment strategy; trial design; user centered design

Project Summary/Abstract My application for a Pathway to Independence Award represents the ideal next step toward reaching my goal of becoming a leading independent investigator focused on the development and evaluation of systems-based approaches for effectively delivering CIH interventions for common chronic conditions. The current application proposes the development and pragmatic pilot testing of a novel CIH-based stepped care approach for co- occurring chronic pain and PTSD. The aims of the proposal strategically align with my specific career development goals of gaining expertise in 1) systems-based care models for complex co-occurring physical and mental health conditions, 2) pragmatic clinical trial design for CIH interventions, and 3) user-centered design strategies for learning health systems. Also included is a professional development goal to 4) ensure my readiness to transition into an independent researcher and faculty member at the rank of Assistant Professor. In addition, the training plan includes 2 goals in the R00 phase of the award: 5) successfully transition into an Assistant Professor position and maintain a successful independent research program; and, 6) conduct a pilot randomized effectiveness trial and use pilot data to write and submit a competitive R01-level grant to NCCIH. The training plan includes an excellent research mentorship team with an established history of consistent independent federal funding and mentorship to ensure that these 6 goals are met. Dr. Steve Zeliadt (Primary Mentor) is an expert in pragmatic trial design, dissemination and implementation science, and quantitative data analysis; Dr. Kurt Kroenke (Co-Mentor) is an expert in systems-based and stepped care models within primary care settings for patients with chronic physical and mental health conditions; and Dr. Rhonda Williams (Co- Mentor) is an expert in pragmatic clinical trial design for CIH interventions and the development, treatment, and theoretical underpinnings of CIH interventions for individuals with complex symptom presentations. In Aim 1, we will use patient semi-structured interviews and clinic focus groups to identify provider strategies and patient perspectives relevant to treating co-occurring chronic pain and PTSD in a primary care clinic. Using proven stepped care approaches developed by mentor Dr. Kroenke for pain and by consultant Dr. Zatzick for PTSD as the foundation, our team will develop a CIH-based stepped care approach for co-occurring chronic pain and PTSD in primary care guided by current evidence of CIH interventions while including patient, provider, and clinic input. In Aim 2, we will iteratively refine the protoype using user-centered design strategies. In Aim 3, we will conduct a pragmatic pilot trial of our CIH-based stepped care approach v. treatment as usual in two primary care settings (one rural, one urban). The experiential components of each aim, combined with my mentorship plan, will ensure my readiness for independence as an expert in the development and evaluation of systems-based approaches for effectively delivering CIH interventions. The training goals and research aims align with the important NCCIH priorities of CIH interventions for co-occurring chronic pain and PTSD and well-being.

项目概要/摘要 我申请独立之路奖代表着实现我的目标的理想下一步 成为专注于基于系统的开发和评估的领先独立研究者 针对常见慢性病有效实施 CIH 干预措施的方法。当前应用 提出了一种基于 CIH 的新型阶梯护理方法的开发和务实试点测试 发生慢性疼痛和创伤后应激障碍。该提案的目标与我的具体职业战略相一致 获得以下方面专业知识的发展目标：1）针对复杂的同时发生的身体和疾病的基于系统的护理模式 心理健康状况，2) CIH 干预措施的实用临床试验设计，以及 3) 以用户为中心的设计 学习卫生系统的策略。还包括职业发展目标，以 4) 确保我的 准备转变为独立研究员和助理教授级别的教员。在 此外，培训计划还包括R00阶段奖励的2个目标：5）成功过渡到 助理教授职位并保持成功的独立研究项目； 6) 进行试点 随机有效性试验，并使用试点数据编写并向 NCCIH 提交竞争性 R01 级资助。 培训计划包括一支优秀的研究导师团队，他们具有一致的历史 独立的联邦资助和指导，以确保这 6 个目标的实现。 Steve Zeliadt 博士（小学 Mentor）是实用试验设计、传播和实施科学以及定量数据方面的专家 分析; Kurt Kroenke 博士（联合导师）是初级保健领域基于系统和阶梯式护理模式的专家 为患有慢性身心健康问题的患者提供护理环境；和朗达·威廉姆斯博士（共同 Mentor）是 CIH 干预措施的实用临床试验设计以及开发、治疗和治疗方面的专家。 针对具有复杂症状表现的个体的 CIH 干预的理论基础。在目标 1 中，我们 将使用患者半结构化访谈和诊所焦点小组来确定提供者策略和患者 与在初级保健诊所治疗同时发生的慢性疼痛和创伤后应激障碍相关的观点。使用经过验证的 由导师 Kroenke 博士针对疼痛和顾问 Dr. Zatzick 针对 PTSD 开发的阶梯式护理方法如下： 在该基金会的基础上，我们的团队将开发一种基于 CIH 的阶梯式护理方法，用于治疗同时发生的慢性疼痛和 初级保健中的 PTSD 以 CIH 干预措施的当前证据为指导，同时包括患者、提供者和诊所 输入。在目标 2 中，我们将使用以用户为中心的设计策略迭代地完善原型。在目标 3 中，我们将 对我们基于 CIH 的阶梯式护理方法与两个初级护理中的照常治疗进行务实试点试验 环境（一处农村，一处城市）。每个目标的体验组成部分，结合我的指导计划， 将确保我准备好独立作为开发和评估基于系统的专家 有效实施 CIH 干预措施的方法。培训目标和研究目标相一致 NCCIH 针对同时发生的慢性疼痛、创伤后应激障碍 (PTSD) 和福祉的 CIH 干预措施的重要优先事项。