Abstract

Background: The VA Community Care program has improved access to surgical care for Veterans unable to have treatment at VA Medical Centers in a timely fashion. However, the delivery of surgical care outside the VA poses barriers to care coordination for pain management during the transitions before and after surgery, leading to increased risk for chronic opioid use (COU). A multidisciplinary approach to perioperative pain management known as the Transitional Pain Service (TPS) has been shown to effectively reduce COU among Veterans after orthopedic surgery, but it is unknown whether this approach can be delivered virtually to reduce COU among at-risk Veterans undergoing similar procedures at non-VA hospitals. Significance: Community Care referrals for orthopedic surgery are very common (>30,000 cases annually) and place Veterans at risk for COU. The proposed study represents a unique opportunity to evaluate a telehealth TPS approach to address care coordination and reduce risks for COU among Veterans when they transition between VA and non-VA surgical care. Innovation & Impact: No prior studies have evaluated the impact of a TPS approach to improve coordination of pain management for Veterans undergoing major surgery at non-VA hospitals. This project presents a unique opportunity to apply an evidence-based approach to help improve the coordination of pain management for Veterans using Community Care for orthopedic surgery at non-VA hospitals and reduce the risk of opioid misuse. Data from this study will be critical to support the broader dissemination of telehealth TPS across the national VHA. Specific Aims: Aim 1. To evaluate a telehealth transitional pain service approach for preventing COU among Veterans referred to non-VA hospitals for orthopedic surgery. Aim 2. To identify barriers and facilitators of care coordination when Veterans undergo orthopedic surgery at non-VA hospitals and use telehealth TPS. Aim 3. To compare patient and payer costs with clinical outcomes among Veterans receiving telehealth transitional pain service versus standard in-person follow-up visits for pain management. Methodology: In Aim 1, we will randomize Veterans referred to non-VA hospitals in VISN-19 for orthopedic joint procedures at two VAMCs to a TPS with regular follow-up telehealth visits after surgery versus only receiving standard care for managing opioid tapering in the 90-days following hospital discharge. In Aim 2, we will conduct interviews with VA providers and Veterans who used Community Care for orthopedic surgery to identify factors that influence coordination of pain management. And in Aim 3, we will estimate patient and VA perspective costs when Veterans use Community Care and perform a cost-effectiveness analysis comparing telehealth TPS to receiving only standard follow-up care with surgical and PCP teams for pain management. Next Steps/Implementation: The research findings from this study will be used to evaluate and refine the telehealth TPS approach designed to improve coordination of pain management for at-risk Veterans undergoing orthopedic surgery at non-VA hospitals. Our study will help identify factors that influence coordination of pain management among Veterans using Community Care and their VA providers, and determine whether a telehealth TPS approach is cost-effective to both patients and payers. There data will determine whether a telehealth TPS approach to coordination of pain management should be dissemination across the VHA.

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DRA: Health Systems, Musculoskeletal Disorders

DRE: Treatment - Comparative Effectiveness, TRL - Applied/Translational

Keywords: Comparative Effectiveness, Rural, Telemedicine/Telehealth

MeSH Terms: None at this time.