Coordinated cARe paiN mAnagement Technology ImplementatiON (CARNATION)

Chronic musculoskeletal pain conditions – common, disabling, costly public health problems – disproportionally 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 non-opioid pharmacological options along with non-pharmacologic therapies (physical interventions, psychological approaches, and complementary and integrative healthcare). Community health centers (CHCs) serving low-income patients face substantial time and resource constraints in ensuring that patients receive guideline-concordant IPM services. Recent expansion of state Medicaid reimbursement for non-opioid pain management services and Medicare coverage for pain care management could help connect CHC patients (most of whom are publicly insured or uninsured) with IPM-congruent services. However, CHC staff lack the health information technology (HIT) infrastructure necessary to track and coordinate such services for their patients, as well as the support needed to use such tools systematically. The new Compass Rose care management application was recently activated in the Epic electronic health record (EHR) platform shared by ~2,000 CHCs in 43 states. This EHR-based tool supports care coordination such as that needed for IPM-congruent care, but integrating it into CHC care processes 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 CHC network to test a multi- component implementation support intervention designed to enable CHCs’ systematic use of Compass Rose for coordinating primary care-based IPM-congruent pain care. This hybrid type 3 implementation-effectiveness randomized trial will: 1. Engage key advisors to tailor Compass Rose to optimize its facilitation of IPM-congruent care and refine the implementation support intervention components; 2. Test the intervention package’s impact on CHCs’ use of the tailored HIT 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. The study will generate urgently needed evidence on how to make IPM care available in CHCs whose limited resources present barriers to the delivery and coordination of such care. Results will provide empirically-based guidance on how to optimize HIT infrastructure and provide related support for its uptake to enhance the primary care-based delivery of coordinated multidisciplinary pain care in CHC populations.