Reaching Rural Veterans: Applying Mind-Body Skills for Pain Using a Whole Health Telehealth Intervention (RAMP-WH)

接触农村退伍军人：通过整体健康远程医疗干预运用身心技能来缓解疼痛 (RAMP-WH)

• 批准号: 10738693
• 负责人: Diana J Burgess
• 金额: $ 127.41万
• 依托单位: CENTER FOR VETERANS RESEARCH AND EDUCATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738693
• 关键词: Address; Adherence; Adoption; Affect; Ambulatory Care Facilities; Awareness; Behavioral; Biophysics; Caring; Chronic; Cognitive; Collaborations; Communities; Complementary Health; Complex; Data Collection; Decision Making; Drug Monitoring; Drug Prescriptions; Education; Enrollment; Ensure; Equity; Evidence based intervention; Exercise; Female; Future; Health system; Healthcare; Healthcare Systems; Hybrids; Integrated Health Care Systems; Integrative Medicine; Intervention; Investments; Knowledge; Learning; Mental Health; Methods; Mindfulness Training; Minority; Modeling; Opioid; Organization and Administration; Outcome; Pain; Pain interference; Pain management; Participant; Patient-Centered Care; Patients; Personal Satisfaction; Phase; Pilot Projects; Practical Robust Implementation and Sustainability Model; Pragmatic clinical trial; Ramp; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Resources; Rural; Rural Health; Safety; Sampling; Self Management; Site; Social Conditions; Substance abuse problem; System; Veterans; Woman; Work; budget impact; care systems; chronic pain; chronic pain management; chronic pain patient; community partnership; comorbidity; design; effectiveness outcome; effectiveness testing; ethnic minority; evidence base; experience; health administration; implementation barriers; implementation intervention; implementation strategy; implementation/effectiveness; improved; innovation; medical specialties; military veteran; mind/body; mindfulness; minority patient; multidisciplinary; non-opioid analgesic; novel; opioid use; pain reduction; prevent; primary outcome; programs; psychologic; racial minority; randomized trial; recruit; relative effectiveness; rural America; rural area; rural patients; rural residence; scale up; secondary outcome; skills; skills training; social; telehealth; treatment as usual; whole health

1 This project addresses the significant challenge of implementing effective, non-opioid interventions for chronic pain 2 management in rural and remote dwelling Veteran populations. Pain is a complex biophysical, psychological, and social 3 (BPS) condition and there is a growing evidence base to support several complementary and integrative health (CIH) 4 approaches, which can address pain in a more holistic way. While the VA has become a leader in advancing CIH through 5 its Whole Health Initiative, there remain many barriers, especially for rural patients. Our team has co-developed, with 6 multiple-levels of VA stakeholders (including rural patients), an innovative telehealth evidence-based intervention that 7 builds upon our team's previous research. The Reaching Rural Veterans: Applying Mind-Body Skills for Pain Using a 8 Whole Health Telehealth Intervention (RAMP-WH) project strategically coalesces multiple evidence based CIH self- 9 management strategies to address Veterans' BPS needs and overcome existing barriers. Comprised of pain education, 10 mindfulness, pain specific exercises, and cognitive behavioral strategies, the program is cohesive and scalable. Designed 11 to be implemented within the VA through its nationwide Whole Health System initiative, it uses VA Whole Health (WH) 12 coaches as program facilitators. RAMP-WH is a 12-week program including a 1-to-1 session with a WH Coach, followed 13 by 11 group sessions including pre-recorded expert led education videos, mind-body skill training and practice, and 14 facilitated discussions. For the preparatory phase (UG3) we will conduct 1) stakeholder engagement activities including 15 identifying and developing new community partnerships and using mixed methods data collection from multiple levels of 16 stakeholders (n=35-50 patients, community partners, VA healthcare system leaders and staff), guided by the established 17 RE-AIM/PRISM framework, to learn about key factors that can affect long-term adoption; and 2) conduct a pilot study of 18 40 rural VA patients with chronic pain to assess the feasibility of delivering RAMP-WH (experimental intervention for 19 the UH3 trial) in terms of recruitment and engagement, intervention fidelity and adherence, data collection, and other key 20 metrics. For the UH3 Phase, we will conduct a randomized hybrid type 2 effectiveness-implementation multi-site 21 pragmatic clinical trial of RAMP-WH compared to Usual Care, among rural patients (n=500) in the VA healthcare 22 system. UH3 Aim 1 will assess the relative effectiveness of RAMP-WH in terms of the primary effectiveness outcome 23 of pain interference at 13 and 26 weeks and secondary outcomes including opioid use and other HEAL recommended 24 outcomes. In UH3 Aim 2 we will work iteratively with multiple levels of stakeholders (from UG3) to evaluate 25 intervention implementation strategies used in the trial and adapt these strategies to scale up RAMP-WH within the 26 national VA healthcare system. This will include: a) conducting mixed-methods assessments of stakeholder and 27 randomized trial participant views of implementation-related barriers and facilitators, resource needs, and other RE- 28 AIM/PRISM domains; b) working with stakeholders to co-create additional plausible strategies for overcoming barriers to 29 implementation of RAMP-WH; and c) conducting budget impact analyses using models informed by stakeholder views to 30 inform future decision making. 31

1该项目解决了针对慢性疼痛实施有效的非阿片类药物干预措施的重大挑战 2农村和偏远的老兵人口管理。疼痛是一种复杂的生物物理，心理和社会 3（bps）条件，越来越多的证据基础支持几种互补和综合健康（CIH） 4种方法，可以以更全面的方式解决疼痛。弗吉尼亚州已经成为通过 5它的整个健康计划，仍然有许多障碍，特别是对于农村患者。我们的团队共同开发了 6个多层VA利益相关者（包括农村患者），这是一种创新的远程医疗循证干预措施，该干预措施 7建立在我们团队以前的研究基础上。到达农村的退伍军人：使用A的心身技巧来痛苦 8整个健康远程医疗干预（RAMP-WH）项目从战略上融合了多个基于证据的CIH自我 9管理策略，以满足退伍军人的BPS需求并克服现有障碍。包括疼痛教育， 10正念，特定于疼痛的运动和认知行为策略，该程序具有凝聚力和可扩展性。设计 11将通过全国范围内的整个卫生系统计划在VA内实施，它使用VA全健康（WH） 12名教练作为计划主持人。 Ramp-WH是一个为期12周的课程 13乘11个小组会议，包括预先录制的专家LED教育视频，身心技能培训和实践以及 14个促进了讨论。对于准备阶段（UG3），我们将进行1）利益相关者参与活动，包括 15识别和发展新的社区伙伴关系，并使用来自多个级别的混合方法数据收集 在既定的指导下 17 RE-AIM/PRISM框架，了解可能影响长期采用的关键因素； 2）进行试点研究 18 40 40个慢性疼痛的农村VA患者，以评估提供坡道的可行性（实验性干预措施 19 UH3试验）在招聘和参与，干预保真度和依从性，数据收集以及其他关键方面 20个指标。对于UH3阶段，我们将进行随机的2型2型有效性多功能多站点 21与常规护理相比，在VA Healthcare的农村患者中，RAMP-WH的务实临床试验（n = 500） 22系统。 UH3 AIM 1将根据主要有效性结果评估RAMP-WH的相对有效性 13和26周的疼痛干扰23，次要结局，包括阿片类药物的使用和其他治疗建议 24个结果。在UH3 AIM 2中，我们将与多个级别的利益相关者（来自UG3）进行迭代工作以评估 25试验中使用的干预实施策略，并适应这些策略以扩大坡道-WH 26国家VA医疗系统。这将包括：a）对利益相关者和 27随机试验参与者对实施相关的障碍和促进者，资源需求以及其他重新的观点 28 AIM/PRISM领域； b）与利益相关者合作，共同创建其他合理策略，以克服障碍 29实施RAMP-WH； c）使用利益相关者观点告知的模型进行预算影响分析 30告知未来决策。 31