Physician Coaching to Reduce Opioid-related Harms
研究概览
详细说明
This project addresses the urgent need to promote the adoption of evidence-based practices in healthcare by pilot-testing an innovative implementation strategy. The implementation strategy aims primarily to reduce variation in opioid prescribing practices for chronic pain in primary care settings.
The standard approach to improving medical practice involves groups of clinical experts reviewing the literature to produce clinical guidelines based on scientific evidence, and disseminating those guidelines by publishing them in medical journals. A clinical guideline has been developed for opioid prescribing for chronic non-cancer pain using this type of approach. The implementation strategy for promoting uptake of the guideline in primary care settings tested in this study consists of three innovations: (1) a process for translating clinical guidelines into a checklist-based implementation guide for clinicians, (2) a physician peer coaching model, and (3) implementation support using tools from systems engineering. This project teams the experts who developed the guideline for opioid prescribing with experts in implementation science and primary care to translate the guideline into an actionable, checklist-based implementation guide. If the implementation strategy is effective in this pilot test, it will be used in a larger cluster-randomized trial to test it against other approaches to evidence-based practice adoption.The long-term goal of this research is to improve the adoption of evidence-based practices in primary care by producing a generalizable model of change.
研究类型
注册 (实际的)
联系人和位置
学习地点
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Wisconsin
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Madison、Wisconsin、美国、53705
- University Of Wisconsin - Madison
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
取样方法
研究人群
描述
Inclusion Criteria:
At each of the 4 coaching intervention sites, we aim to recruit between 3-7 clinical care providers with prescribing authority (e.g., primary care physicians, mid-level practitioners, etc.) to participate in interviews and focus groups. All clinic staff (e.g., medical assistants, office staff) are welcome to participate in coaching site visits and follow up correspondence, but only staff with prescribing authority will be considered research participants.
Exclusion Criteria:
- Residents will be excluded.
学习计划
研究是如何设计的？
设计细节
队列和干预
团体/队列 |
干预/治疗 |
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Physician coaching
This group includes 4 intervention primary care clinics that are part of the University of Wisconsin's Department of Family Medicine.
These clinics will receive an organizational coaching intervention that includes in-person site visits and phone/email communication.
Each participating clinic will designate one primary care physician to act as a clinic lead in working with the coach to coordinate an initial site visit (during project month 13, July 2015), a follow-up site visit (month 15, October, 2015), and communicating with the coach throughout the 6-month follow-up period via phone and email.
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The coach will present the latest research on the benefits and risks of long-term opioid use. The presentation will be followed by a brainstorming exercise where the coach joins the clinic team in experiencing clinical practices from the perspective of a patient with chronic pain. The coach will help the clinic team flowchart clinical workflows and determine the best course for implementing aspects of a checklist-based implementation guide developed to support adoption of the guidelines for opioid prescribing. The coach will help the team implement ideas using Plan-Do-Study-Act change cycles. The coach will maintain monthly email and phone contact with the clinic lead and clinic team after the initial site visit to monitor implementation progress and offer advice. |
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Control Group
This group includes 4 control primary care clinics that will not receive any intervention.
A de-identified dataset will be created to examine differences in outcome variables between intervention and control clinics.
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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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Overall Rate of Opioid Prescribing
大体时间：Up to 3 years
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The proportion of patients with a chronic pain diagnosis receiving daily opioids.
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Up to 3 years
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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Rate of Opioid / Benzodiazepine Co-prescribing
大体时间：Up to 3 years
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Proportion of patients with a chronic pain diagnosis receiving daily opioids and benzodiazepines concurrently.
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Up to 3 years
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Urine Drug Screening Rate
大体时间：Up to 3 years
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Proportion of opioid patients completing urine drug screens prior to and during the study intervention
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Up to 3 years
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Mental Health Screening Rate
大体时间：Up to 3 years
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Proportion of opioid patients screened for mental health/substance use problems
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Up to 3 years
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Use of Pain Management Agreements
大体时间：Up to 3 years
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Proportion of opioid patients signing pain management agreements
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Up to 3 years
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High-dose Patients
大体时间：Up to 3 years
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Proportion of opioid prescriptions above 120 mg daily morphine equivalent
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Up to 3 years
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Provider Drop-out Rate
大体时间：3 months
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Number and percentage of providers who drop out of study at 3 months
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3 months
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Participating Patient Demographics
大体时间：Up to 3 years
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Characteristics of participating patients vs. general patient population (race, gender, ethnicity)
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Up to 3 years
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Participating Clinic Characteristics
大体时间：Up to 12 months
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Characteristics of participating clinics vs. non-participating clinics (number of patients, number of providers, overall opioid prescribing rate)
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Up to 12 months
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Participating Staff Characteristics
大体时间：Up to 12 months
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Characteristics of participating staff (profession)
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Up to 12 months
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Intervention Fidelity
大体时间：Up to 12 months
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Total hours of coaching delivered/received among all clinics that received physician coaching.
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Up to 12 months
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Intervention Cost
大体时间：Up to 12 months
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Total cost of coaching intervention among all clinics that received physician coaching.
At clinic level.
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Up to 12 months
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Proportion With MEDD >120 mg
大体时间：Up to 12 months
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The proportion of patients who have consistent opioid Rx above a morphine equivalent daily dose about 120 mg.
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Up to 12 months
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Average Morphine Equivalent Daily Dose (MEDD)
大体时间：Up to 12 months
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The average MEDD in milligrams for patients with consistent opioid Rx.
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Up to 12 months
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合作者和调查者
调查人员
- 首席研究员：Andrew R Quanbeck, PhD、Center for Health Enhancement Systems Studies
出版物和有用的链接
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.
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