Salud de tu Espalda Primary Care to Physical Therapy (STEPPT): Mitigating ethnic disparities in access and engagement in spine pain rehabilitation

Salud de tu Espalda 从初级保健到物理治疗 (STEPPT)：减少脊椎疼痛康复获取和参与方面的种族差异

• 批准号: 10753365
• 负责人: Sara P Gombatto
• 金额: $ 60.72万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-13 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10753365
• 关键词: Address; Adherence; Affect; Award; Behavioral; Caring; Clinic; Clinical; Clinical Practice Guideline; Clinical Trials; Cognitive; Communities; Consult; Consultations; Continuity of Patient Care; Development; Effectiveness; Electronic Health Record; Evidence based intervention; Evidence based program; Exposure to; Family health status; Federally Qualified Health Center; Focus Groups; Goals; Guidelines; Health; Health Disparities Research; Health Personnel; Health Professional; Healthcare; Healthcare Systems; Hispanic; Hispanic Populations; Improve Access; Individual; Inequity; Information Technology; Institution; Intervention; Latino Population; Linguistics; Low Back Pain; Low income; Managed Care; Manuals; Medical Care Costs; Methods; Mexico; Modeling; Musculoskeletal Pain; National Institute on Minority Health and Health Disparities; Navigation System; Neck; Not Hispanic or Latino; Pain; Pain management; Participant; Patients; Physical Rehabilitation; Physical therapy; Physicians; Primary Care; Productivity; Provider; Quality of life; Randomized; Recommendation; Recurrence; Reporting; Research Design; Research Project Grants; Risk; Self Efficacy; Services; Severities; Spine pain; Surveys; System; Testing; Therapeutic Intervention; Therapeutic exercise; United States; United States Dept. of Health and Human Services; United States National Institutes of Health; Universities; access disparities; clinical infrastructure; compliance behavior; cost; disparity reduction; effectiveness evaluation; efficacy testing; environmental stressor; ethnic disparity; ethnic minority; evidence base; feasibility testing; hispanic community; improved; medical specialties; minority health; minority health disparity; musculoskeletal injury; pain reduction; pain rehabilitation; patient engagement; poor health outcome; preference; primary care provider; primary outcome; programs; psychological stressor; racial minority; recruit; social stressor; standard care

Project Summary Spine pain is among the most common and disabling health conditions for both non-Hispanic whites (NHWs) and racial/ethnic minorities. Although Hispanics often report more severe musculoskeletal pain than NHWs, they are less likely to consult a healthcare professional for pain management, and health care providers are less likely to assess and treat pain in Hispanic patients. The overall objective of this proposal is to adapt and test evidence-based, culturally informed practices at multiple levels of influence along the healthcare continuum to improve access to and engagement in physical rehabilitation as a non-pharmacological treatment option for Hispanics with spine pain. Aim 1 proposes a mixed-methods approach to adapt and manualize a multilevel intervention to address modifiable factors contributing to ethnic disparities in rates of physician referral and patient adherence to physical therapy referral for spine pain in a Federally Qualified Health Center (FQHC) serving diverse, low-income communities near the US-Mexico border. Aim 2 will then assess effectiveness of the manualized intervention, referred to as STEPPT (Salud de tu Espalda: Primary Care to Physical Therapy), using a cluster-randomized stepped-wedge clinical trial in the FQHC setting. Compared to standard care, we hypothesize that STEPPT will significantly reduce ethnic disparities in rates of physician referral and patient adherence to physical therapy referral for spine pain. Successful completion of the proposed aims will provide underserved Hispanic communities with scalable, sustainable, and effective options for engaging in culturally appropriate pain care. This approach can serve as a model for FQHCs and other healthcare systems to mitigate disparities in specialty services for a variety of health conditions that disproportionately impact ethnic and racial minorities.

项目概要 对于非西班牙裔白人 (NHW) 来说，脊柱疼痛是最常见且最严重的健康问题之一 和少数种族/族裔。尽管拉美裔人经常报告比 NHW 更严重的肌肉骨骼疼痛， 他们不太可能咨询医疗保健专业人员进行疼痛管理，而医疗保健提供者 不太可能评估和治疗西班牙裔患者的疼痛。该提案的总体目标是适应和 在医疗保健领域的多个影响层面测试基于证据、文化背景的实践 继续改善身体康复作为非药物治疗的可及性和参与度 患有脊椎疼痛的西班牙裔人的选择。目标 1 提出了一种混合方法来适应和手动化 多层次干预，以解决导致医生比例种族差异的可改变因素 转诊和患者对物理治疗的依从性转诊到联邦合格的健康中心治疗脊柱疼痛 (FQHC) 为美国-墨西哥边境附近的多元化低收入社区提供服务。然后目标 2 将评估 手动干预的有效性，称为 STEPPT（Salud de tu Espalda：初级保健 物理治疗），在 FQHC 环境中使用整群随机阶梯楔形临床试验。相比 标准护理，我们假设 STEPPT 将显着减少医生比率的种族差异 转诊和患者对脊柱疼痛物理治疗转诊的依从性。圆满完成了 拟议的目标将为服务不足的西班牙裔社区提供可扩展、可持续和有效的选择 参与适合文化的疼痛护理。这种方法可以作为 FQHC 和其他方法的模型 医疗保健系统，以减少针对各种健康状况的专业服务的差异 对少数族裔和种族的影响尤为严重。