Engaging Veterans Seeking Service-Connection Payments in Pain Treatment

让寻求服务连接付款的退伍军人参与疼痛治疗

• 批准号: 10013125
• 负责人: Marc I Rosen
• 金额: $ 130.24万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10013125
• 关键词: Age; Alcohol or Other Drugs use; Algorithms; Award; Back; Behavior; Brief Pain Inventory; Caring; Chronic; Clinical; Clinical Trials; Communication; Conduct Clinical Trials; Cost Analysis; Counseling; Distress; Early Intervention; Electronic Health Record; Evaluation; Financial compensation; Health Promotion; Healthcare Systems; Human Resources; Individual; Injury compensation; Institutional Review Boards; Intervention; Interview; Joints; Measures; Mediating; Mediator of activation protein; Medical Records; Medical center; Military Personnel; Multi-Institutional Clinical Trial; Musculoskeletal; Musculoskeletal Diseases; Nail plate; Natural Language Processing; Neck; New England; Opioid; Outcome; Outcome Assessment; Outcome Measure; Pain; Pain interference; Pain management; Patient Self-Report; Phase; Populations at Risk; Preparation; Procedures; Professional counselor; Protocols documentation; Quality of life; Randomized; Records; Risk; Secure; Services; Severities; Site; Site Visit; Source; Telephone; Testing; Text; Toxicology; Veterans; base; chronic pain; cost effective; cost effectiveness; cost estimate; design; early phase clinical trial; effectiveness testing; experience; functional improvement; high risk; implementation strategy; improved; informant; innovation; motivational enhancement therapy; multimodality; pain outcome; pain reduction; pain relief; pain symptom; payment; pragmatic trial; primary outcome; psychologic; recruit; screening; screening, brief intervention, referral, and treatment; secondary outcome; service utilization; structured data; substance abuse treatment; substance misuse; symptomatic improvement; treatment as usual; willingness to pay

Abstract In 2015 alone, 97,223 new Veterans under age 35 began receiving compensation for injuries related to their military service. In total, there are 559,999 post-9/11 Veterans being compensated for back or neck conditions, and a partially overlapping 596,250 for limitation of flexion in joints. Veterans seeking compensation for musculoskeletal conditions often develop chronic pain and are at high risk for substance misuse. Early intervention is needed to arrest worsening pain and risky substance use, particularly among post-9/11 Veterans for whom engagement in non-pharmacological pain treatment has the potential to improve their overall quality of life and spare them the complications of opioid treatments. The service-connection application is an ideal point-of-contact for initiating early intervention treatments for these at-risk Veterans. We propose to test the effectiveness and cost-effectiveness of Screening, Brief Intervention and Referral to Treatment for Pain Management (SBIRT-PM), designed to reduce pain and risky substance use. In brief, the counselor explains that treating both physical and psychological aspects of pain leads to the best outcomes, outlines what VA (and non-VA if preferred) services are available to Veterans, explains that substances are sometimes used for pain relief, and segues into traditional SBIRT. SBIRT-PM's efficacy is supported by a completed clinical trial of 101 Veterans applying for service-connection for MSD, and by studies showing the efficacy of SBIRT for people with risky substance use and of Motivational Interviewing for engagement in non-pharmacological pain care. The study will involve a two-year period to arrange for clinicians at a single “hub” site to counsel Veterans throughout New England by phone with SBIRT-PM, and a four-year period to conduct the clinical trial and disseminate its findings. During the two-years of preparation for the clinical trial, the team will prepare SBIRT-PM for implementation by establishing communication (Relational Coordination is the theoretical framework) between the “hub” where the SBIRT-PM clinician is sited and the “spoke” sites, establishing study- related procedures, and piloting the intervention at each of the eight VA medical centers in New England. For the full clinical trial, we will randomize 1200 Veterans applying for compensation related to MSD to either SBIRT-PM or Usual Care (UC) across eight VA medical centers in New England. Outcome assessment by phone will occur at 12 and 36-week follow-ups, and will be corroborated with other sources of information ---the electronic health record and toxicology testing of nail clippings. We hypothesize that, compared to Usual Care, SBIRT-PM will be more effective and cost-effective in improving Veterans' pain and substance use. We further hypothesize that a mediator of these improvements will be use of non-pharmacological services, as extracted from VA records from structured data fields and from narrative text in the medical record using an innovative natural language processing algorithm. Screening and referral to treatment at service-connection examinations can transform a widely-used point of entry to VA into a health-promoting encounter.

抽象的 仅在2015年，有97,223名35岁以下的新退伍军人开始接受与他们的伤害的赔偿 兵役。总共有559,999名后9/11名退伍军人被补偿，以赔偿背部或颈部条件， 以及部分重叠的596,250，以限制关节的屈曲。寻求赔偿的退伍军人 肌肉骨骼状况通常会出现慢性疼痛，并且有滥用物质的高风险。早期的 需要干预以阻止担心疼痛和危险的药物使用，尤其是在9/11之后 参与非药物疼痛治疗的退伍军人有可能改善他们的 整体生活质量，并保留阿片类药物治疗的并发症。服务连接应用程序 是为这些高危退伍军人推出早期干预治疗的理想接触点。我们建议 测试筛查的有效性和成本效益，简短干预并转介到疼痛的治疗 管理（SBIRT-PM），旨在减少疼痛和风险使用物质。简而言之，辅导员解释说 疼痛的身体和心理方面都可以带来最佳结果，概述了什么VA （如果首选（如果首选），则可以向退伍军人提供服务，解释说有时用于 缓解疼痛，并将种子变成传统的sbirt。 SBIRT-PM的效率得到了完整的临床试验的支持 101名退伍军人申请MSD的服务连接，并通过研究表明SBIRT的效率 有风险的药物使用和动机访谈以参与非药物疼痛的人 关心。这项研究将涉及为期两年的时间来安排一个“枢纽”网站上的临床医生以咨询 新英格兰的退伍军人通过电话与SBIRT-PM，以及四年进行临床试验 并传播其发现。在为期两年的临床试验准备工作中，团队将准备 通过建立沟通来实施SBIRT-PM（关系协调是理论上的 框架）在位置SBIRT-PM临床的“枢纽”与“辐条”站点之间建立研究 - 相关程序，并在新英格兰的八个VA医疗中心中的每个中心试行干预。为了 完整的临床试验，我们将将1200名退伍军人随机申请与MSD相关的补偿 新英格兰八个VA医疗中心的SBIRT-PM或通常的护理（UC）。结果评估 电话将在12周和36周的随访中进行，并将与其他信息来源一起证实--- 指甲剪接的电子健康记录和毒理学测试。我们假设这是与通常的护理相比 SBIRT-PM将在改善退伍军人的痛苦和吸毒者的使用方面更有效和成本效益。我们进一步 假设这些改进的调解人将使用非药物服务，如提取 从结构化数据字段的VA记录和医疗记录中的叙事文本使用创新 自然语言处理算法。筛查和转介在服务连接时进行治疗 考试可以将通往VA的广泛进入点转变为促进健康的遭遇。