Courtney Rena E, Schadegg Mary J, Hicks Natalie, Truitt Melissa, Bolton Rendelle E, Dezzutti Brian, Cannizzo Francis, Darnall Beth D, Radatz Marilyn, Harden Samantha M
PREVAIL Center for Chronic Pain, Salem VA Health Care System, Salem, VA, USA.
Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Blacksburg, VA, USA.
Glob Adv Integr Med Health. 2024 Oct 13;13:27536130241290798. doi: 10.1177/27536130241290798. eCollection 2024 Jan-Dec.
Chronic pain is highly prevalent in US military Veterans, and pain interdisciplinary teams (IDTs) are the gold standard in pain care. There is no standard or guidance for how best to develop and implement pain interdisciplinary teams within complex health care systems.
The purpose of this quality improvement project was to evaluate the effectiveness of the standard 9-step Lean 6 Sigma (LSS) methodology in redesigning a pre-existing VA outpatient pain clinic solely offering interventional pain services into an efficient, sustainable pain IDT program.
The initial evaluation process at a VA Medical Center that primarily serves rural Veterans was redesigned with the a priori goal of developing an efficient, sustainable IDT program that decreased driving days (ie, in-person appointments) required for a comprehensive initial pain evaluation, decreased number of consults required for initial pain evaluations, increased the number of consults to Whole Health services, and increased compliance with policies and standards. Feedback from administrators, clinicians, and Veterans was used to identify inefficiencies then iteratively design, test, and finalize a redesigned service called the PREVAIL Interdisciplinary Team Track (PREVAIL IDT Track). Baseline data was collected for 1 year followed by sustainment data for 14 months. Results were analyzed using descriptive statistics.
PREVAIL IDT Track decreased the number of in-person appointments from 5 to 2, decreased consults required for evaluations from 5 to 1, increased the number of unique consults to Whole Health education classes, and made the VA fully compliant with policies and standards. To date, 486 Veterans have participated in the redesigned program, including 167 graduates and 212 current enrollees in this sustained clinical program.
The success of PREVAIL IDT Track suggests that LSS may be a promising method for redesigning sustainable pain IDTs in VA that improve efficiency.
慢性疼痛在美国退伍军人中极为普遍，疼痛跨学科团队（IDT）是疼痛护理的金标准。在复杂的医疗保健系统中，对于如何最好地组建和实施疼痛跨学科团队，尚无标准或指导意见。
本质量改进项目的目的是评估标准的9步精益六西格玛（LSS）方法在将一个仅提供介入性疼痛服务的退伍军人事务部（VA）门诊疼痛诊所重新设计为一个高效、可持续的疼痛IDT项目中的有效性。
对一个主要为农村退伍军人服务的VA医疗中心的初始评估流程进行了重新设计，其先验目标是开发一个高效、可持续的IDT项目，该项目可减少全面初始疼痛评估所需的驾车天数（即面对面预约），减少初始疼痛评估所需的会诊次数，增加向整体健康服务的会诊次数，并提高对政策和标准的遵守情况。利用来自管理人员、临床医生和退伍军人的反馈来识别低效率之处，然后迭代设计、测试并最终确定一个重新设计的服务，称为“战胜跨学科团队路径”（PREVAIL IDT Track）。收集了1年的基线数据，随后收集了14个月的维持数据。使用描述性统计分析结果。
PREVAIL IDT Track将面对面预约次数从5次减少到2次，将评估所需的会诊次数从5次减少到1次，增加了参加整体健康教育课程的独特会诊次数，并使VA完全符合政策和标准。迄今为止，已有486名退伍军人参与了重新设计的项目，包括167名毕业生和212名该持续临床项目的当前参与者。
PREVAIL IDT Track的成功表明，LSS可能是一种很有前景的方法，可用于在VA中重新设计可持续的疼痛IDT，以提高效率。
