Adapting and Implementing a Nurse Care Management Model to Care for Rural Patients with Chronic Pain

适应和实施护理管理模式来护理农村慢性疼痛患者

基本信息

批准号：
10741606
负责人：
Kushang Patel
金额：
$ 154.56万
依托单位：
UNIVERSITY OF WASHINGTON
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：
2023-08-18 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10741606
关键词：
Address Adult Aerobic Exercise Affect Age Alaska American Analgesics Anxiety Area Behavior Caring Case Manager Chronic Cognitive Therapy Communities Counseling Data Disparity Education Ethnic Origin Exercise Gender Geography Goals Health Insurance Health Professional Health Services Accessibility Health system Healthcare Systems Heterogeneity Household Idaho Income Individual Infrastructure Insurance Coverage Intervention Interview Learning Life Measures Mental Depression Mental Health Modeling Montana North Carolina Nursing Care Management Opioid Outcome Outcome Measure Pain Pain intensity Pain interference Pain management Patients Pattern Phase Physical Function Population Primary Care Process Quality of life Race Randomized, Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Reporting Research Resources Rural Rural Community Services Sleep Sleep disturbances Social Functioning Subgroup Substance Use Disorder Testing Training United States United States National Institutes of Health Variant Washington Wyoming biopsychosocial care coordination chronic pain chronic pain management chronic pain patient collaboratory comorbidity daily functioning disability dosage effectiveness evaluation effectiveness/implementation design evidence base exercise program experience fitness health care service health care service utilization high risk implementation evaluation implementation outcomes improved innovation intervention program mental function opioid overdose pain catastrophizing patient engagement patient subsets pilot test poor health outcome post intervention practice-based research network primary outcome programs recruit remote delivery response rural area rural patients rural residence rurality satisfaction secondary outcome strength training treatment as usual treatment effect

项目摘要

PROJECT SUMMARY Chronic pain affects over 20% of the U.S. adult population and frequently has debilitating effects on quality of life and physical and mental functioning. Individuals living in rural communities experience higher rates of chronic pain as well as poorer health outcomes because of pain. The 46 million Americans who live in rural areas frequently lack access to evidence-based, non-pharmacologic treatments for chronic pain. As such, a critical need exists to implement effective, comprehensive programs for pain management that include non- pharmacologic treatment options. Nurse care management (NCM) has been successfully used to enhance care for individuals with other chronic conditions or at high risk of complications. Using a type 2 hybrid effectiveness-implementation design, we propose to adapt, pilot, and implement a NCM model that includes care coordination, cognitive behavioral therapy (CBT), and referrals to a remotely delivered exercise program for rural patients with chronic pain. Each health system will identify appropriate health care professionals to be trained as care managers. For the CBT component, care managers will be trained to engage patients in a remotely delivered CBT program. For exercise, we will offer remotely delivered Enhance Fitness, which is an evidence-based, 16-week program that includes aerobic and strength training exercise. In the UG3 phase, we will engage patients, clinicians, and care managers from 2 health systems serving rural patients in a learning collaborative to pilot the NCM model. In addition, we will adapt infrastructure and workflows to implement the intervention program and engage the partnering health systems in developing relationships with community partners and identifying care managers. In the UH3 phase, we will conduct a randomized controlled trial of the adapted NCM model versus usual care in rural dwelling patients with chronic pain. We have recruited 6 health systems from 2 practice-based research networks, the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) region Practice and Research Network and the Mecklenburg Area Partnership for Primary Care Research in rural North Carolina. Our primary outcome is pain interference as measured by the Pain, Enjoyment of Life and General Activity (PEG) scale. Our secondary outcomes include physical function, sleep, pain catastrophizing, depression, anxiety, treatment satisfaction, substance use disorder, pain medication use/dosage including opioids, and health care utilization. We will explore if disparities exist by examining heterogeneity in treatment effects via subgroup analyses by age, gender, race/ethnicity, and health insurance. We will use the RE-AIM framework to assess implementation outcomes and qualitative interviews conducted with a subset of patients to evaluate experiences with the intervention. If successful, this study will have a transformative effect on chronic pain management in rural areas by expanding access to evidence-based, non-pharmacologic treatments through an innovative NCM model.

项目概要超过 20% 的美国成年人受慢性疼痛影响，并且经常对生活质量产生破坏性影响生命和身心功能。居住在农村社区的个人的患病率较高慢性疼痛以及因疼痛而导致的健康状况较差。 4600 万美国人生活在农村这些地区经常缺乏针对慢性疼痛的循证非药物治疗方法。因此，一个迫切需要实施有效、全面的疼痛管理计划，其中包括非药物治疗选择。护士护理管理（NCM）已成功用于增强照顾患有其他慢性病或并发症高风险的个人。使用 2 型混合有效性实施设计，我们建议调整、试点和实施 NCM 模型，包括护理协调、认知行为治疗 (CBT) 以及转诊至远程医生为农村慢性疼痛患者提供锻炼计划。每个卫生系统将确定适当的医疗保健专业人员接受护理管理者培训。对于 CBT 部分，护理经理将接受过培训，让患者参与远程 CBT 项目。对于锻炼，我们将提供远程交付增强健身，这是一个基于证据的、为期 16 周的计划，包括有氧训练和力量训练锻炼。在 UG3 阶段，我们将让来自 2 个卫生系统的患者、临床医生和护理管理者参与进来通过学习合作为农村患者提供服务，试点 NCM 模式。此外，我们还将调整基础设施和工作流程来实施干预计划并让合作卫生系统参与制定与社区合作伙伴的关系并确定护理管理者。在UH3阶段，我们将进行农村居民慢性病患者的适应 NCM 模型与常规护理的随机对照试验疼痛。我们从 2 个基于实践的研究网络 WWAMI（华盛顿，怀俄明州、阿拉斯加州、蒙大拿州和爱达荷州）地区实践和研究网络以及梅克伦堡地区北卡罗来纳州农村初级保健研究伙伴关系。我们的主要结果是疼痛干扰通过疼痛、生活享受和一般活动（PEG）量表来衡量。我们的次要成果包括身体功能、睡眠、灾难性疼痛、抑郁、焦虑、治疗满意度、物质使用疾病、止痛药的使用/剂量（包括阿片类药物）以及医疗保健的利用。我们将探讨是否存在差异通过按年龄、性别、种族/民族进行亚组分析来检查治疗效果的异质性，和健康保险。我们将使用 RE-AIM 框架来评估实施成果和定性对一部分患者进行访谈，以评估干预体验。如果成功的话，这研究将通过扩大获得药物的机会，对农村地区的慢性疼痛管理产生变革性影响通过创新的 NCM 模型进行基于证据的非药物治疗。