Sebastian Tong

March 9, 2026: AIM-CP Nurse Care Management Program Shows Promise for Rural Patients With Chronic Pain

Posted on by Damon Seils
Headshots of Dr. Sebastian Tong and Dr. Kushang Patel
Dr. Sebastian Tong and Dr. Kushang Patel, principal investigators for AIM-CP

A pilot study of the AIM-CP intervention showed that an integrated nurse care management model is a feasible and effective way to deliver nonpharmacological chronic pain treatment to patients in rural communities. The findings will inform a full-scale randomized controlled trial to evaluate the intervention’s impact on a larger scale.

The results were published online ahead of print in Pain Medicine.

Rural residents experience higher rates of chronic pain but often lack access to evidence-based alternatives to opioids, such as cognitive behavioral therapy and exercise therapy. AIM-CP, an NIH Collaboratory Trial led by principal investigators Sebastian Tong and Kushang Patel of the University of Washington, will test a virtual nurse care management model that includes care coordination, cognitive behavioral therapy, and referral to a virtual exercise program.

The pilot study, conducted with 29 participants across healthcare systems in Washington and North Carolina, showed the intervention was feasible and had a high level of acceptability to patients. Participants experienced significant reductions in pain interference and improved satisfaction with their health. While adherence to nurse-led sessions was strong, the researchers observed low uptake for the exercise component, a challenge the team plans to address through enhanced training and support in the larger randomized trial.

AIM-CP is supported within the NIH Pragmatic Trials Collaboratory through the NIH HEAL Initiative by a grant from the National Institute of Nursing Research. Learn more about AIM-CP.

December 8, 2025: New Podcast Explores Partnership Between Rural-Focused Research Network and BeatPain, an NIH Collaboratory Trial

Posted on by Sophia Ramirez

In a new episode of the Rethinking Clinical Trials Podcast, Julie Fritz of the University of Utah and Sebastian Tong of the University of Washington expanded on key takeaways from their recent Grand Rounds presentation, “Integrating the BeatPain Study With PRaCTICe, a New Network Research Hub of the CARE for Health Initiative.”

Listen to the podcast. For alerts about new episodes, subscribe for free on Spotify, Amazon Music, Apple Podcasts, or SoundCloud.

In an effort to connect patients in rural areas with innovative care, the Primary Care Rural and Frontier Clinical Trials Innovation Center (PRaCTICe) partnered with BeatPain. In the podcast, Fritz and Tong discuss what made the partnership a good fit.

“The BeatPain study was meeting a need that clinicians that patients had identified: access to non-pharmacological treatments for chronic pain that are evidence-based in many places there just wasn’t access to physical therapy,” said Tong.

Roughly a year into their collaboration, PRaCTICe had referred 165 patients to the BeatPain team, 95% of which were rural residents. Fritz and Tong each shared some of their lessons learned around building trust and capacity in low resource settings.

“Local people who support what you’re doing, that you build relationships with so they know that you’re doing the best you can by the participants that come out of their clinics, I think that’s been key to building successful partnerships. Both at the clinical level and at the patient level,” said Fritz.

BeatPain Utah, an NIH Collaboratory Trial, is comparing the effectiveness of nonpharmacologic intervention strategies for patients with back pain seeking care in federally qualified health centers throughout the state of Utah.

Fritz is the principal investigator for BeatPain Utah and a distinguished professor of physical therapy and athletic training at the University of Utah. Tong is a co–principal investigator for AIM-CP, an NIH Collaboratory Trial, and an associate professor of family medicine at the University of Washington.

Podcast November 26, 2025: Integrating the BeatPain Study With PRaCTICe, a New Network Research Hub (Julie M. Fritz, PhD, PT, FAPTA; Sebastian Tong, MD, MPH)

Posted on by Sophia Ramirez

In this episode of the NIH Collaboratory Podcast, Drs. Julie Fritz and Sebastian Tong expand on key takeaways from their recent Grand Rounds presentation, "Integrating the BeatPain Study With PRaCTICe, a New Network Research Hub of the CARE for Health Initiative."

Read the transcript. For alerts about new episodes, subscribe for free on Spotify, Amazon Music, Apple Podcasts, or SoundCloud.

Grand Rounds October 10, 2025: Integrating the BeatPain Study With PRaCTICe, a New Network Research Hub of the CARE for Health Initiative (Julie M. Fritz, PhD, PT, FAPTA; Sebastian Tong, MD, MPH)

Posted on by Sophia Ramirez

Speakers

Julie M. Fritz, PhD, PT, FAPTA
Distinguished Professor
Department of Physical Therapy & Athletic Training University of Utah

Sebastian Tong, MD, MPH
Associate Professor
University of Washington

Keywords

Engagement; Community-Engaged Research; Rural; Pain; Partnership

Key Points

  • In an assessment of 10 high-income nations, the United States ranked 10th in healthcare system performance despite maintaining a significant lead in terms of healthcare spending.
  • The capacity of clinical research to improve healthcare is limited by a lack of representation. Patients who are older; live in rural locations; are uninsured; have co-morbid conditions; belong to minority groups; and are more likely to receive non-standard treatment are all inadequately represented in trials.
  • The NIH CARE for Health Initiative seeks to address these interrelated challenges. It will develop infrastructure for a clinical research network focused on primary care (PC); establish a foundation for sustained engagement with underrepresented communities; implement innovative study designs; integrate research into routine PC without increasing the burden on providers; and facilitate the adoption of evidence-based research findings.
  • CARE for Health is based in 6 national research hubs. One is the Primary Care Rural and Frontier Clinical Trials Innovation Center (PRaCTICe), a research network partnering with 300 PC practices serving 7 underrepresented population across Oregon, Washington, Wyoming, Alaska, Montana, and Idaho.
  • PRaCTICe utilizes a continuum of community engagement, from outreach to shared leadership. Engagement strategies have included community needs assessment reviews, regional listening sessions, and a new study development process that involves co-designing studies with PRaCTICe partners.
  • In 2024, BeatPain – a pragmatic, decentralized, NIH Collaboratory Trial – was selected as 1 of 2 trials PRaCTICe would partner with during Year 1. By the presentation date, PRaCTICe had referred 165 patients to the BeatPain team, 95% of which were rural residents.
  • Rural populations simultaneously have higher incidence of chronic pain and are less likely to receive evidence-based, nonpharmacologic treatment for it. BeatPain seeks to serve this population by delivering physical therapy (PT) to federally qualified health center patients with lower back pain.
  • Over the course of their collaboration with PRaCTICe, BeatPain investigators have made strides in terms of localizing the study to partnering communities, building trust with referring providers and patients, and coordinating the end of the trial. Decentralized trial methods hold promise for engaging rural residents and clinics in clinical research.

Discussion Themes

Relationships between research staff and a variety of clinic staff were critical to effective engagement. In one example provided by Dr. Tong, staff helped identify which exercises were most effective when it came to getting providers interested in the referral process. Clinics were not passive recipients, but co-developers.

To deliver PT in a rural setting, the BeatPain team delivered a virtual intervention combining traditional PT, health coaching, motivational interviewing, and pain coping strategies. In some care processes, the hands-on component of PT is essential; less so for chronic pain. Strategic use of technology could expand access to nonpharmacologic care.

Research teams will need to be responsive to shifts in the capacity of rural hospitals and clinics due to funding cuts. This may look like designing interventions that don’t increase the burden on staff; supplying resources; and sharing strategies that clinics can use to be financially sustainable.

IT support proved central to the success of this partnered research. When clinic resources are constrained, the ability to help solve problems related to the electronic health record is essential.

October 8, 2025: Engaging Rural Communities in Pragmatic Clinical Trials, in This Week’s Rethinking Clinical Trials Grand Rounds

Posted on by Sophia Ramirez

In this Friday's Rethinking Clinical Trials Grand Rounds, Julie Fritz of the University of Utah and Sebastian Tong of the University of Washington will present "Engaging Rural Communities in Pragmatic Clinical Trials: Leveraging the CARE for Health Initiative Hubs to Enhance Enrollment for BeatPain."

The Grand Rounds session will be held on Friday, October 10, 2025, at 1:00 pm eastern.

BeatPain Utah, an NIH Collaboratory Trial, is comparing the effectiveness of nonpharmacologic intervention strategies for patients with back pain seeking care in federally qualified health centers throughout the state of Utah.

Fritz is the principal investigator for BeatPain Utah and a distinguished professor of physical therapy and athletic training at the University of Utah. Tong is a co–principal investigator for AIM-CP, an NIH Collaboratory Trial, and an associate professor of family medicine at the University of Washington.

Join the online meeting.

July 2, 2025: Researchers Share Tips for Embedding Pragmatic Trials Into Primary Care Settings

Posted on by Karen Staman

Headshots of Drs. Wendy Weber, Julie Fritz, Natalia Morone, and Sebastian TongAlthough the need for pragmatic research in primary care settings is great, conduct of pragmatic clinical trials in these settings remains nascent. In a session at the NIH Pragmatic Trials Collaboratory’s 2025 Annual Steering Committee Meeting, Wendy Weber of the National Center for Complementary and Integrative Health (NCCIH) led a discussion about how to expand pragmatic research into primary care settings.

The panelists included Julie Fritz, principal investigator (PI) for BeatPain Utah; Natalia Morone, PI for OPTIMUM; and Sebastian Tong, co-PI for AIM-CP. They shared some of the challenges of conducting research in primary care.

  • Primary care physicians have multiple competing demands for attention and focus, and a range of topics to cover in a single visit.
  • The expectation of being offered participation in clinical trials is lower in primary care than in specialty visits.
  • There are fewer resources that can be diverted to research in primary care, especially time and personnel.

Key Takeaways

How do we adapt pragmatic clinical trials to primary care?

Identify relevant and meaningful research questions

The panelists suggested that, when planning a trial, investigators should think about the primary care setting and consider what problems keep clinicians up at night. Research will be easier to implement if it helps alleviate these problems.

“In primary care, [primary care physicians] are looking at the entire person,” Tong said. “There has to be value added in how we care for the patients with the condition under study, either where the [physician] sees a difference in their patients’ lives or their own lives with respect to reduced burden,” he said.

The panelists also suggested that, for community health centers, there are certain conditions that are linked to data reporting standards, and aligning research with these standards will make studies easier to champion.

Adapt to different kinds of primary care settings

The panelists stressed the need for adaptably and flexibility in intervention delivery because all primary care settings are different. If  possible, researchers should tailor the workflow at each site in a way that is familiar to providers. the panelists also suggested that initial engagement by external researchers is best made with someone who is trusted at the site.

Some clinics, including community health centers, may be new to research and may need additional support. Many do not have an institutional review board or a Federalwide Assurance number, and many do not have experience using the electronic health record for research and developing data use agreements.

About the Trials

  • BeatPain Utah, supported by the National Institute of Nursing Research (NINR), is comparing the effectiveness of nonpharmacologic interventions delivered via telehealth for patients with back pain seeking care in federally qualified health centers in Utah.
  • OPTIMUM, supported by NCCIH, is assessing the impact of a group-based mindfulness intervention for patients with chronic back pain under usual care circumstances in the primary care setting.
  • AIM-CP, supported by NINR, is testing the implementation of a care management program to address disparate access to nonpharmacological treatments for chronic pain in rural populations.

This summer, we are sharing highlights from the 2025 Annual Steering Committee Meeting.  Access the complete collection of meeting materials.

June 27, 2024: NIH HEAL Initiative Turns Attention to Pragmatic Trials in Rural Communities

Posted on by Damon Seils

Three of the newest NIH Collaboratory Trials are supported through the NIH HEAL Initiative℠, or Helping to End Addiction Long-Term Initiative℠, reflecting a special emphasis on developing strategies for the management of chronic pain in rural and remote populations.

“There are many known disparities between urban and rural populations,” said Karen Kehl, a program director at the National Institute of Nursing Research (NINR). “And when we talk about chronic pain, we know that there’s a higher incidence and a higher severity of pain in rural populations, and yet they don’t have access to many of the effective solutions that we have,” Kehl added.

We recently spoke with Kehl, Julie Fritz of the BeatPain Utah trial, and the principal investigators of the AIM-CP, ARBOR-Telehealth, and RAMP trials at the NIH Collaboratory’s 2024 Annual Steering Committee Meeting. They discussed the progress of their studies and the importance of supporting healthcare and promoting health equity in rural communities through pragmatic research.

AIM-CP

 AIM-CP will test the implementation of a care management program to address inequities in access to nonpharmacological treatment for chronic pain in rural populations. The principal investigators are Kushang Patel and Sebastian Tong of the University of Washington. The study is supported by NINR. Learn more about AIM-CP.

ARBOR-Telehealth

 ARBOR-Telehealth will evaluate the use of a telehealth physical therapy strategy for patients who present to primary care clinics with low back pain in rural communities. The principal investigators are Richard Skolasky and Kevin McLaughlin of Johns Hopkins University. The study is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Learn more about ARBOR-Telehealth.

RAMP

 RAMP will evaluate the use of a 12-week mind-body skills training program for rural veterans with pain, including a one-on-one session with a “whole health coach” followed by 11 weekly group sessions to include prerecorded expert-led education videos, mind-body skills training and practice, and group discussions. The principal investigators are Diana Burgess and Roni Evans of the University of Minnesota and Katherine Hadlandsmyth of the University of Iowa. The study is supported by NINR. Learn more about RAMP.

Learn more about the NIH Collaboratory Trials.