PCORI funds Dissemination and Implementation projects to increase awareness and promote the use of PCORI research findings to improve healthcare practices and health outcomes. This project is proposing to conduct dissemination and implementation activities for the results of the research project: Using Surveys to Assess Patient-Centered Factors that May Affect Responses to Chronic Pain Treatment.
What research finding is this project disseminating?
The original PCORI study measured patient’s perspectives on their healthcare experiences while in treatment for chronic pain. We used the Healing Encounters and Attitudes Lists (HEAL) context factors assessments, which we recently developed using PROMIS® methodology. We found that several nonspecific or contextual factors were important to patients, such as Treatment Expectations, the Patient‐Provider Connection, and overall Positive Outlook. These factors were also important predictors of patients’ treatment outcomes. The current proposed project will implement the (HEAL) context factor questionnaires into pain management clinical settings, as well as research settings. Because such context factors assessment is novel and innovative, it is important to work closely with staff as they learn to adopt the HEAL and use the results to improve patient‐provider engagement and enhance care experiences.
Why is this research finding important?
Which treatments are most helpful for which patients is a question that is important to both clinicians and patients. Our research finding contributed to understanding regarding this question. Patients who have higher expectations regarding their treatments, and those who have positive outlooks in general, typically have better outcomes than those whose expectations and outlooks are lower. Thus, tools to measure these factors, and training in how to address these factors in the clinical encounter could enhance care through improved communication.
What is the goal of the dissemination project?
The overall objective is to implement HEAL assessments into clinical practice in UPMC Pain Medicine clinics to improve the care experiences of patients and their healthcare providers. A secondary activity is to implement HEAL and related PROMIS assessments into research studies at the University of Pittsburgh and nationally through HealthMeasures/PROMIS as well as department of psychiatry research platforms.
Aim 1: the primary aim is to implement HEAL context factors measurement in a clinical setting
Phase 1. Preparation for adoption: a) conducting formative evaluations with patients and clinicians; and b) training key clinician stakeholders to assist with further implementation activities.
Phase 2. Implement HEAL assessments into clinic procedures: a) include HEAL measures in existing online patient assessment (CHOIR) and reporting system; and b) provide training to clinic staff in how to hold meaningful conversations with patients regarding HEAL reports.
Phase 3. Evaluate success of implementation strategies: a) short term: process evaluations / observations (acceptability, implementation as expected); b) intermediate term: Evaluate access rates: proportion of patients who complete online questionnaires, proportions of clinical encounters during which reports are accessed and discussed; c) longer term: summative evaluations with clinic staff; evaluate associations between HEAL use and patient reported treatment outcomes (effectiveness).
Aim 2: the secondary aim is to implement HEAL context factors and PROMIS measurement into research projects.
- conduct formative evaluations with research principals using HEAL
- provide online access to HEAL and PROMIS measures for researchers locally in Pittsburgh and nationally/internationally
What is the project team doing?
After interviewing pain clinic staff and patients about their values and needs regarding using HEAL context factors as part of treatment, the team will implement the HEAL questionnaires into the existing patient online assessments. We will conduct facilitator trainings to engage the clinical teams in using the HEAL scores to initiate conversations with patients about their perspectives on treatment. The project team will evaluate whether the HEAL are implemented as planned, and whether they are successful in improving patient‐provider engagement and outcomes. Secondarily, the team will implement HEAL assessments and associated training in research settings.
How will the project team evaluate their dissemination activities?
The project team will evaluate their activities in the short term by observing clinical encounters (process evaluations) to see how the HEAL scores are used to help initiate conversations with patients about their treatment expectations and the patient‐provider connection. We will evaluate proportions of patients who complete the HEAL questionnaires and proportions of clinic visits in which HEAL reports are used (intermediate‐term). Finally, as the project draws to a close, we will evaluate associations between HEAL scores and treatment outcomes, and interview patients and clinicians regarding the potential for ongoing use of HEAL as part of the treatment process (summative interviews). We will also conduct summative interviews with researchers as part of our secondary Aim, implementing HEAL into research projects.
How is the project team involving patients and others in this dissemination project?
We have a stakeholder advisory panel made up of patients, student researchers, and researcher/clinicians. Some of these individuals have already assisted with dissemination efforts. Patients voices, as well as those of clinicians and researchers, are central to this project. Over 50 such stakeholders will participate in formative, process, and summative evaluations.
How will this project help ensure future uptake and use of PCORI results?
This project includes integration of HEAL into existing online assessment systems: CHOIR and HealthMeasures. Additionally, this project will produce a blueprint for facilitating adoption of improved tools for assessment and communication in clinical and research settings.
Learn more about PCORI’s Dissemination and Implementation program here.
Original PCORI-funded Project
Note: Results from the original project have completed PCORI’s Peer Review and are available here.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.