Among Veterans, chronic non-cancer pain is highly prevalent (up to 50% of patients) and a major contributor to poor health-related quality of life. Primary care teams, responsible for most of chronic pain care in VHA, report feeling overburdened, under-resourced and generally ill-equipped to meet the needs of patients with chronic pain. The net result in some cases is low quality pain care that is unsatisfactory for patients and providers and sometimes unsafe. As such, consistent with recommendations from the Institute of Medicine and the Department of Health and Human Services, the overall impact goal of this program of projects is to improve safe and effective pain management through partnered implementation of personalized, proactive, patient-centered interventions that optimize access to care. The content and methods of the projects are closely tied with five key areas in the VHA's Blueprint for Excellence. VHA has been a leader in developing novel interventions to promote safe and effective pharmacologic and non-pharmacologic pain care. This proposal takes the next steps by implementing evidence-based interventions to translate innovation into improved quality of care and empower Veteran self-management. To improve function and quality of life and also decrease morbidity and mortality among patients with chronic pain, a growing body of research and expert consensus support multi-modal pain care, in which evidence-based non-pharmacologic treatment modalities are incorporated alongside pharmacologic treatment and reduction in high-dose opioid therapy and avoidance of opioid-benzodiazepine combination therapy. Although efficacious non-pharmacologic interventions exist, determining which patients might be best served by which interventions is a challenge for primary care and referral to specialty programs often is overly complex, time-consuming or even unavailable. To address needs for specific strategies and tools, we have assembled an expert team of implementation scientists, clinical researchers with extensive expertise in pain management and partnered with clinical leadership to create a consortium of inter-related and complementary projects that address cross-cutting quality gaps in pain care. Specific project objectives include developing and refining implementation tools and strategies that facilitate uptake and increase access to evidence-based, multi-modal pain management services. To this end, we will develop an informatics tool that will support the proactive identification of patients through automated case finding. We will optimize the implementation strategy through formative work, guided by the Consolidated Framework for Implementation Research, to identify factors that facilitate or hinder uptake of the interventions. Also, we will evaluate the effectiveness of the implementation strategies on uptake of the evidence-based, multi-modal pain management services, with an emphasis on unburdening PACTs and conserving local resources. From the initial development of the proposal through the formative and summative evaluations, we will partner with the National Pain Management, Primary Care, and Pharmacy Benefits Management program offices to refine, evaluate, and disseminate these programs and policy initiatives that promote safe, effective, patient-centered pain care.

Public Health Relevance

The objective of this QUERI Program is to improve pain management for Veterans through partnered implementation of personalized, proactive, patient-centered interventions that optimize access to effective pain care. The proposed QUERI Program will facilitate uptake of and increase access to a suite of evidence-based multi-modal pain management services with an emphasis on unburdening patient aligned care teams. This program will establish a menu of approaches to support provision of safe and effective pharmacological interventions and promote access to evidence-based behavioral interventions for Veterans with chronic pain. If successful, similar approaches could be used to improve the efficiency of chronic disease management services for patients with depression, hypertension, diabetes, and other priority conditions that require pharmacological and non-pharmacological interventions.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (IP1)
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QUERI Program Review (HQ8)
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VA Connecticut Healthcare System
West Haven
United States
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