Scaling Interoperable Clinical Decision Support for Patient-Centered Chronic Pain Care - PROJECT SUMMARY/ABSTRACT
The U.S. continues to face public health crises related to both chronic pain and opioid overdoses. Thirty
percent of Americans suffer from chronic noncancer pain at a cost of $600 billion annually. Most patients with
chronic pain first turn to primary care clinicians, who must choose from myriad treatment options based on
relative risks and benefits, patient history, symptoms, and goals. Recently, with attention to opioid-related risks,
prescribing has declined. However, clinical experts have countered with concerns that some patients, for whom
opioid-related benefits outweigh risks, are being inappropriately discontinued from opioids. Unfortunately,
primary care clinicians lack usable tools to help them partner with their patients in choosing pain treatment
options that best balance risks and benefits in the context of patient history, symptoms, and goals. Thus,
primary care clinicians and patients would benefit from patient-centered clinical decision support (CDS) for this
shared decision making process. The objective of this three-year proposal is to study the adaptation and
implementation of an existing interoperable CDS tool for pain treatment shared decision making, with tailored
implementation support, in new clinical settings in the OneFlorida Clinical Research Consortium. Our central
hypothesis is that tailored implementation support will increase CDS adoption and shared decision making. We
further hypothesize that increases in shared decision making will lead to improved patient outcomes, pain and
physical function. The proposed study builds on our team’s nearly ten-year history of research to design,
implement, and evaluate CDS for pain care. The study responds to AHRQ’s PA-20-074 and aligns with
AHRQ’s interest in opioid-related research (NOT-HS-18-015), and use of Fast Healthcare Interoperability
Resources (FHIR) (NOT-HS-19-020). The CDS implementation will be guided by the Exploration, Preparation,
Implementation, Sustainment (EPIS) framework. The evaluation will be organized by the Reach, Effectiveness,
Adoption, Implementation, and Maintenance (RE-AIM) framework. Our specific aims are: 1) Adapt and tailor
Pain Manager, AHRQ’s interoperable CDS tool, for implementation in primary care clinics affiliated with the
OneFlorida Clinical Research Consortium; 2) Evaluate the effect of tailored implementation support on Pain
Manager’s adoption for pain treatment shared decision making; and 3) Establish the feasibility and obtain
preliminary data in preparation for a multi-site pragmatic trial targeting the effectiveness of Pain Manager and
tailored implementation support on shared decision making and patient-reported pain and physical function.
The research will generate evidence on strategies for implementing interoperable CDS in new clinical settings
across different types of electronic health records. The study will also inform tailored implementation strategies
to be further tested in a subsequent hybrid effectiveness-implementation trial. Together, these efforts will lead
to important new technology and evidence that patients, clinicians, and health systems can use to improve
care for millions of Americans who suffer from pain and other chronic conditions.
