Adapting and Implementing a Nurse Care Management Model for Rural Primary Care Patients with Chronic Pain

Chronic pain affects 20% of U.S. adults and has debilitating effects on quality of life and function. Individuals living in rural communities experience high burden of chronic pain and frequently lack access to evidence-based, non-pharmacologic treatments. A critical need exists to implement effective, comprehensive programs for pain management that include non-pharmacologic treatments. The purpose of this study is to adapt and implement a nurse care management (NCM) model that includes care coordination, cognitive-behavioral therapy (CBT), and referrals to a remotely delivered exercise program for rural patients with chronic pain to improve pain-related outcomes. Using a type 2 hybrid effectiveness-implementation design, we will engage two practice-based research networks in WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) and North Carolina in a two-phase study. In phase 1, we will engage two health care systems to pilot the NCM model with 30 patients. Care managers will be trained and then provide care coordination, CBT and referrals to a tele-exercise program to patients for 6 months. In phase 2, we will conduct a randomized controlled trial of the adapted NCM model versus usual care in 408 rural dwelling patients. Our primary outcome is pain interference and intensity as measured by the PEG scale. We will use the RE-AIM framework to assess implementation outcomes. If successful, this study will have a transformative effect on chronic pain management in rural areas by expanding access to evidence-based treatments through an innovative NCM model. Funding: National Institutes of Health HEAL Initiative (UG3NR020930-01).