A core component of stepped-care for pain management is ensuring primary care providers and patients have access to specialty pain care services. VISNS20 has developed a hub-spoke TelePain model to help ensure patients seen in rural CBOCs across Washington, Alaska, Oregon, and Idaho do not have to travel to an urban medical center to see a pain specialist. This program was initiated in 2016 and to date has been focused on supporting 4 CBOCs in Washington State. Although the program is well utilized, delivering over 1,300 visits to these CBOC patients and has served as a substitute for Veterans having to travel to the Medical Center in Seattle, this program has not been as fully utilized. Beginning in 2019, this hub-spoke model will be expanded to CBOCs in Alaska and Oregon. The purpose of this project is to use external facilitation to ensure the TelePain program is adopted by these CBOCs as rapidly as possible. The study team will travel to Alaska and Oregon to conduct rapid analytic process facilitation activities with providers and staff as the TelePain program in launched in these sites in Mid-2019. The study team will also conduct qualitative interviews with Veterans who do and do not use TelePain. This project will compare the experience of implementing TelePain using facilitation in these new CBOCs with the historical experience in the original 4 Washington CBOCs which did not benefit from external facilitation. The purpose of this work is to assess the value and return-on-investment of external facilitation and help VISN 20 leadership understand the value of supporting implementation activities when launching new clinical initiatives. A facilitation toolkit will be developed with the goal of supporting facilitation when expanding TelePain to additional rural CBOCs. The lessons learned from the facilitation activities will also be applied to the original CBOCs to help increase adoption and utilization of TelePain referrals among those CBOC providers and patients.
Chronic pain is a key contributor to the opioid epidemic. Veterans are twice as likely to die from an opioid overdose as non-Veterans, and rural Veterans are at an even higher risk. Despite serving such a high risk population, rural community-based outpatient clinics (CBOCs) often lack the resources for opioid tapering and delivery of comprehensive chronic pain care. The VISN 20 hub-spoke TelePain Initiative is an innovative model for delivering evidence-based, multimodal pain care from a dedicated specialty pain team in a central ?hub? in Seattle, WA to rural CBOC ?spokes? throughout a 4-state region. TelePain offers medication assisted therapy for opioid use disorder, case management, psychological therapies, and movement therapies via telehealth. This proposal will evaluate the use of external facilitation in 6 rural CBOCs (4 in Alaska and 2 in Oregon) to increase the reach of TelePain services. A business impact analysis will describe the cost of conducting external facilitation as well as ongoing delivery costs to guide VISN 20 leadership in future investments.
