QUERI – Quality Enhancement Research Initiative

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Expanding TelePain Across VISN20


For Veterans who live in more rural and/or remote areas, there is a lack of access to evidence-based, multimodal pain care. TelePain is a telehealth intervention for improving access to pain treatment options, including pain education, group psychotherapies for pain, acupuncture education, yoga and tai chi, and opioid safety interventions. These telehealth options are particularly important for Veterans with chronic pain who reside in rural and/or remote settings.


TelePain QUERI Investigators will use external facilitation strategies to improve timely referral to specialty pain care for at-risk Veterans as TelePain services are rolled out to Anchorage, AK and White City, OR. The goal of this effort is to demonstrate the value of external facilitation as an implementation strategy by comparing the reach achieved in Anchorage and White City to the reach observed in the first year of TelePain in the four VA community-based outpatient clinics (CBOCs) in the Puget Sound area, where external facilitation was not used. This work will result in an external facilitation toolkit that can be used in the original four CBOCs, as well as additional rural locations throughout VISN 20 and VISN 19, who have expressed interest in adopting our TelePain model. 

In addition, a business impact analysis will describe the cost of conducting external facilitation and ongoing delivery costs. The focus of this analysis will be to guide VISN 20 leadership in future investments for further expansion and maintenance of the TelePain program compared to alternatives.


TelePain QUERI investigators will:

  • Use external facilitation, rapid analytic process (RAP), and iterative refinement for hub-spoke implementation of TelePain targeting rural at-risk Veterans in Alaska and White City, Oregon.
  • Monitor RE-AIM outcomes guided by the stepped-care model to ensure at-risk Veterans are effectively using multiple available services including psychological care, medication-assisted treatment, movement therapies and complementary and integrative health services. They also will examine unfacilitated TelePain in Puget Sound community-based outpatient clinics.
  • Conduct economic and business impact analyses of the early TelePain implementation to help guide long-term sustainability of TelePain throughout VISN 20.

Anticipated Impacts:

Practice implementation will occur within VISN 20 (Northwest Network) at six clinics – four in Alaska and two in Southern Oregon. It is expected that the TelePain Program will be made available through video teleconferencing to all CBOCs and eligible Veteran homes in the four-state region (Alaska, Idaho, Oregon, and Washington). “Our goal with the TelePain Program is to reduce Veteran suicide risk, increase opioid safety and access to care, while reducing travel burden,” said Michael Tadych, VA Puget Sound director. “The program also seeks to increase collaboration among VA clinicians across departments and sites, to enhance the coordination for Veterans with complex treatment needs—including opioid tapering.” [2018 – a Great Year for VA Puget Sound.]

Thus far, TelePain QUERI investigators have found that without external facilitation support, the reach of specialty pain services to CBOC patients only increased by 0.2% in VA Puget Sound.

Reach of Timely Referral and Utilization of Specialty Pain Care

Principal Investigators: Steven Zeliadt, PhD, Steven.Zeliadt@va.gov and Jessica Chen, PhD, Jessica.Chen663@va.gov

Operations Partners: VISN 20: Nicholas Potochny, MD, Deputy Chief Medical Officer, and VISN 20 Pain Committee member, Cynthia Joe, MD, Chief of Staff, Alaska VA Healthcare System.