Project Summary

Chronic musculoskeletal pain conditions—common, disabling, costly public health problems—disproportionately impact persons of lower socioeconomic status and are a primary driver of medical care. Current chronic pain care guidelines recommend multimodal, integrative pain management (IPM) involving nonopioid pharmacological options along with nonpharmacological therapies (physical interventions, psychological approaches, and complementary and integrative healthcare). Community health centers serving lower-income patients face substantial time and resource constraints in ensuring that patients receive guideline-concordant IPM services. Recent expansion of state Medicaid reimbursement for nonopioid pain management services and Medicare coverage for pain care management could help connect patients in community health centers (most of whom are publicly insured or uninsured) with IPM-congruent services. However, staff of community health centers lack the health information technology infrastructure necessary to track and coordinate such services for their patients, as well as the support needed to use such tools systematically. Integrating electronic health record (EHR) technologies, including Compass Rose and other enabling technologies, care management applications recently activated in the shared OCHIN Epic platform support care coordination needed for IPM-congruent care. However, integrating such EHR tools into care processes at community health centers involves complex clinic-wide practice changes requiring implementation support. Effective strategies for providing such support are needed. To identify and optimize such strategies, we will partner with this national community health center network to test a multicomponent implementation support intervention designed to enable community health centers’ systematic use of EHR technologies including Compass Rose for coordinating primary care–based, IPM-congruent pain care. This hybrid type 3 effectiveness-implementation randomized trial will (1) engage key advisors to tailor existing EHR technologies to optimize their facilitation of IPM-congruent care and refine the implementation support intervention components; (2) test the intervention package’s impact on community health centers’ use of the tailored health information technology tools and on patient pain-related outcomes; and (3) conduct formative evaluation and budget impact analyses to understand and explain intervention Reach, Effectiveness, Adoption, Implementation, and Maintenance (REACH). The study will generate urgently needed evidence on how to make IPM care available in community health centers, where limited resources present barriers to the delivery and coordination of such care. Results will provide empirically based guidance on how to optimize health information technology infrastructure and provide related support for its uptake to enhance the primary care–based delivery of coordinated multidisciplinary pain care in community health center populations.

NIH Project Information