Even though 45-85% of older adults (age ?65 years) suffer from chronic pain, little evidence exists for how to treat their chronic pain effectively. Furthermore, the number of OAs diagnosed with a substance use disorder has increased, and the proportion of OAs with heroin use has more than doubled from 2012-2015. Despite the scope of these problems, pain remains inadequately controlled in many OAs, and there are few tailored interventions for OAs with opioid use disorder (OUD). AHRQ has called for patient-centered clinical decision support (PCCDS) strategies to be central to quality improvement projects to address safe and effective chronic pain management, opioid use, and OUD treatment. University of Chicago Medicine (UCM) has integrated safe opioid prescribing into the EHR and clinical workflow, resulting in increased physician levels of awareness, perceived usefulness, and self-reported guideline-concordant practice of many key CDC recommendations. Shared decision making (SDM) is a highly effective collaborative framework when there is uncertainty about the optimal treatment choice, a scenario which commonly exists for OAs with pain. Access Community Health Network (ACCESS), a large Federally Qualified Health Center network in the Chicago metropolitan area, has embedded SDM as part of how they assess patient goals and preferences. In addition, UCM has effectively used Project ECHO?, a tested model for delivery of subspecialized medical knowledge to community providers, to improve self-efficacy and practice behaviors in geriatrics competencies for urban medical providers, as well as disseminate best practices regarding OUD. The goal of this proposal is to determine whether development and implementation of a geriatric-informed PCCDS-SDM toolkit (Improving Chicago Older Adult Opioid and Pain Management through PCCDS and Project ECHO (I-COPE) Program) for managing chronic pain, chronic opioid use, and OUD improves clinical outcomes for Chicago's most vulnerable OAs.
In Aim 1, we will use a user-centered design to create the I-COPE Program.
In Aim 2, we will evaluate the dissemination, implementation, and effectiveness of the I-COPE Program across >25 clinic using a stepped wedge design. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) will be used to evaluate the program. With these aims, this grant will lead to an understanding of how and EHR-based PCCDS alongside an SDM framework, disseminated via Project ECHO, can improve chronic pain, opioids and OUD in OAs.
Even though older adults suffer inordinately from chronic pain, little evidence exists for how to treat their chronic pain effectively. Shared decision making and patient-centered clinical decision support are highly promising strategies to approach clinical care for older adults with chronic pain, opioid use and opioid use disorder. We will determine whether development and implementation of a geriatric-informed patient-centered clinical decision support and shared decision making toolkit, using the training dissemination platform Project ECHO, improves clinical outcomes for Chicago's most vulnerable older adults.
