QUERI – Quality Enhancement Research Initiative

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Improving Pain-Related Outcomes for Veterans (IMPROVE)

West Haven, CT and Palo Alto, CA

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Improving Pain-Related Outcomes for Veterans  logoAmong Veterans treated in the VA healthcare system, chronic non-cancer pain is highly prevalent (up to 50% of patients) and a major contributor to poor health-related quality of life. Consensus recommendations from expert groups discourage sole reliance on pharmacologic strategies to treat these patients and encourage multi-modal approaches. IMPROVE QUERI strives to optimize safe and effective pain management through partnered implementation of personalized, proactive, patient-centered interventions that increase Veterans’ access to multi-modal care.

Improving Pain-Related Outcomes for Veterans  diagram

Findings and Expected Impacts:

The Academic Detailing to Improve Pain Management (ADQI) project identified best practices and lessons learned in the VISN 21 Pharmacy Benefits Management (PBM) AD program to help other VISNs implement opioid-related AD programs. IMPROVE QUERI provided guidance to National PBM’s AD program on how to facilitate more successful implementation of academic detailing in the VA healthcare system. Suggested strategies included linking high-performing detailers with detailers at struggling sites and providing education on best practices to struggling sites, to name a few.

The Primary Care-Integrated Pain Support (PIPS) project studies the implementation of a pharmacist-led pain care program designed to decrease the number of Veterans receiving high-dose opioid and combination opioid-benzodiazepine therapy, while increasing engagement with non-pharmacologic pain treatment. Pre-implementation interviews revealed prominent themes, including both system- and patient-level barriers. PIPS is expected to help VA Primary Care align pain treatment with evidence-based, consensus recommendations with respect to opioid safety and multimodal pain care, thereby reducing the risk of serious opioid-related consequences while preserving patients’ quality of life and functional status.

The Cooperative Pain Education and Self-management (COPES) project reaches Veterans without access to pain management resources by using technology to provide cognitive-behavioral therapy (CBT) in Veterans’ homes. It is expected that the use of technology to facilitate wider access to CBT, especially in lower resourced areas, is likely to dramatically increase the number of Veterans with access to evidence-based, non-pharmacological care for chronic pain – and to enhance the geographic reach of these services.

Principal Investigators: Will Becker, MD, (William.Becker4@va.gov); Alicia Heapy, PhD, VA (Alicia.Heapy@va.gov); and Amanda Midboe, PhD, (Amanda.Midboe@va.gov) .

Operations Partner(s): Pain Management, Primary Care, National Pharmacy Benefits Management (including Academic Detailing), VISN 21 Pharmacy Benefits Management, and the Office of Patient Centered Care & Cultural Transformation.