JMIR Publications

ABSTRACT

Background:

Veterans are more likely to experience chronic pain, compared to civilians, with significant negative impacts on long-term health outcomes. Evidence for effectiveness of prescription opioids for chronic pain management is limited; and chronic use of opioids is associated with increased risk of sleep-disordered breathing, cardiovascular complication, and bowel dysfunction, as well as opioid misuse and overdose. Veterans Affairs and Department of Defense (VA and DoD) guidelines is prioritizing low-risk, evidence-based interdisciplinary pain management strategies while optimizing pain-related outcomes for veterans. Commission on Accreditation of Rehabilitation Facilities (CARF)-Accredited VA Interdisciplinary Pain Rehabilitation Programs (IPRPs) have shared characteristics, while maintaining their unique characteristics as individual pain management programs. Though little is known about characteristics of VA’s IPRPs (e.g., staffing, services, patients served), implementation, and sustainability of these mandated programs.

Objective:

The goals of our operational partner driven evaluation are to: 1) characterize IPRPs across multiple program factors, including but not limited to, service delivery method(s), team composition, program characteristics, services and modalities offered, patients served; 2) triangulate data to inform data visualization to characterize and illustrate the IPRPs individually and collectively as a system of care; and 3) identify patient reported outcomes (PROs) and metrics to measure program effectiveness and determine overlap across IPRPs.

Methods:

This partnered driven program evaluation will use a sequential mixed-methods process. Rapid content analysis will be used to iteratively analyze qualitative data, while descriptive statistics will be used to analyze quantitative data. Data sets will be triangulated to support data visualization for partners to inform clinical and operational decision support.

Results:

Data collection began in February 2024 and is currently ongoing. The results and deliverables will inform VA CARF-accredited IPRP characterization, evaluation, and implementation as a learning health system.

Conclusions:

The results of this evaluation will characterize CARF-accredited IPRPs and identify determinants affecting the implementation of this complex intervention, made up of multiple evidence-based practices. Partner driven data will inform the state of implementation at each site, and quantitative measures will provide options for collecting standardized outcome measures for ongoing program evaluation. This operational partner driven evaluation will inform ongoing efforts for quality improvement to improve veterans’ pain management outcomes. This protocol informs the use of a mixed-methods approach to evaluate a multimodal intervention (i.e. IPRP), made up of multiple evidence-based practices to treat a complex comorbid condition. Future work may include data management infrastructure development and cost evaluations to inform clinical and operational decision making.