Health Services Research & Development

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CREATE: Pain Management and Patient Aligned Care


Director: Joseph Goulet, Ph.D.

Principal Investigators:

About the CREATE

In 2011, the Institute of Medicine reported that as many as one-third of all Americans experience persistent pain. The report also noted that Veterans are an especially vulnerable group, with a particularly high prevalence for pain, and very high rates of other complex, multiple medical and mental health concerns.

This CREATE program has three specific goals:

  • Enhance Veterans' access to empirically validated and guideline-concordant pain care;
  • Leverage health information technology to promote better pain care for Veterans; and
  • Build sustainable improvements in pain care that are applicable beyond the life of the CREATE.
 

Partner Offices

Each CREATE works closely with operational partners throughout the VA System. Partners for this program include the:

"One of the core principles that defines VA's transformation into a culture of Veteran-centered care is to "Provide for physical comfort and pain management." The aims of this CREATE are entirely consistent with our shared objectives of promoting a unified view of the patient, including a focus on prevention, reduction of risk, and maintenance of health and function. Projects will improve quality and clinical usefulness of pain screening; promote guideline concordant pain care, particularly safe and effective long-term opioid therapy; and provide important information on pain management to directly support the strategic plan of the National Pain Management Program Office and other patient care and operations partners."
- Rajiv Jain, M.D., Former Assistant Deputy USH for VA Patient Care Services


Projects

This CREATE initiative includes three funded projects:

  • Musculoskeletal Diagnoses Cohort: Examining Pain and Pain Care in the VA
    This study will characterize the population of Veterans with musculoskeletal diagnoses (MSD) with regard to the long-term course of their pain diagnosis, along with other co-occurring conditions such as depression and substance use disorders, pain care and outcomes, and costs of care. This project addresses and incorporates both decision support and clinical information systems. It is expected that an early deliverable (the end of Project Year 1) will be an MSD cohort database available for use by program partners and other investigators, including the other CREATE project investigators. The database should contribute answers to scientific and clinical operations' questions regarding MSD-related pain and pain management.
    (PI: Joseph Goulet, Ph.D.)
  • Effective Screening for Pain
    This three-site (Los Angeles, Minneapolis, Portland) study aims to evaluate the effects of an enhanced, computer-aided pain screening and assessment protocol to allow for the use of pain and functioning scores as an alternative to the 0-10 clinician-assessed, numerically-based pain rating scale. Further goals include assessing factors affecting implementation and use of pain ratings, including multidisciplinary perspectives from Patient Aligned Care Teams (PACT), as well as the development of an informatics prototype for linking screening to management. This project will use both clinical information systems and prepared, proactive practice teams to accomplish its objectives. Project results will help improve quality and clinical usefulness of 'the 5th Vital Sign' in VHA primary care.
    (PI: Karl Lorenz, M.D.)
  • Comprehensive Opioid Management in Patient Aligned Care Teams (COMPACT)
    The COMPACT study will test a telehealth-based self-management training system to promote improved care for Veterans receiving chronic opioid therapy. The primary aims are to evaluate the effectiveness of the intervention in improving physical and emotional functioning, opioid safety, and quality of life. This project incorporates self-management support—supporting informed and activated patients—and delivery system design. Because the COMPACT makes use of widely-accessible automated telephone technology, it broadens access to guideline-concordant pain care, and it can be delivered with consistency, thereby reducing variability in care.
    (PI: Alicia Heapy, Ph.D., and John Piette, Ph.D.)

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