Healthcare Optimization

Please find information about USU Department of Anesthesiology's current research endeavors in the Healthcare Optimization domain, as well as who to contact in each of the drop down boxes below.

 

This study aims to describe variation in pain management and analgesia utilization patterns prior to, during, and after procedures within a Health Equity Measurement Framework, as well as outcomes associated with such variation. Though randomized clinical trials provide indication as to the efficacy of a given intervention, the translation of efficacy data to real world evidence (effectiveness) can be highly variable. This "efficacy-effectiveness gap" can stymie healthcare optimization, patient outcomes, and healthcare costs. As such, it is essential to evaluate the real world evidence of pain management and analgesia pathways leading up to surgical procedures, during procedures, and in the days and months following procedures. The results from this study can be used to support improvements in programs, policies, formularies, and care pathways.

  • Lead Researchers: Kyle Cyr, MD (kyle.l.cyr.mil@mail.mil ),  Krista Highland, PhD (krista.highland.ctr@usuhs.edu)

This study examines the inpatient acute pain service delivery over the past decade at the DOD’s only level I trauma center, Brooke Army Medical Center (BAMC). Analyses will describe utilization tempo, types of encounters and interventions, and additional factors related to healthcare optimization as they relate to operational deployments occurring at the time (e.g., deployment surges during conflicts). The research team aims to look at the last eleven years of BAMC data and report back the number of treatment encounters and determine whether or not there are correlations with overseas operational deployments occurring at the time (i. e deployment surges during conflicts). In a similar fashion, we also want to examine the use of novel treatments such as methadone, epidural analgesia, and peripheral nerve catheter analgesia, etc. We aim to identify if active U.S military conflicts have any correlation or effect to SAMMC’s acute pain services.  

  • Lead Researcher: Michael Patzkowski, MD, MHA  (michael.s.patzkowski.mil@mail.mil)

  • Outcomes:

    • In Progress

This study is examining the prevalence of chronic widespread pain (CWP) and gastrointestinal (GI) conditions and their comorbidity, as well as their treatment pathways. The research team aims to identify the prevalence of CWP and GI conditions individually, and the degree to which each one increases the risk of the other, up to 3 years after the index diagnosis (this will identify the CWP-only, GI-only, and comorbid cohorts). Additionally, the research team will identify the prevalence of mental health comorbidities for CWP-only, GI-only, and comorbid cohorts.  

  • Lead Researcher: Michael Patzkowski, MD, MHA (michael.s.patzkowski.mil@mail.mil), Germaine Herrera, MS (germaine.herrera.ctr@usuhs.edu), Krista Highland, PhD (krista.highland.ctr@usuhs.edu)

This study will examine dronabinol prescription patterns and outcomes in the MHS from 2006-2021, relative to other pain medications (e.g., opioids, NSAIDS, acetaminophen, gabapentinoids). The research team aims to describe patient and care characteristics associated with probability of receiving dronabinol relative to other pain medications. Additionally, the study will describe prescriber patterns for dronabinol, the effectiveness of dronabinol relative to other pain medications, and the probability of reducing opioid doses. 

  • Lead Researcher: Michael Patzkowski, MD, MHA  (michael.s.patzkowski.mil@mail.mil)

This study, conducted inn collaboration with the University of Utah, explores ways to tailor pain management based on risk for long-term opioid use; examines mediators of pain management outcomes to identify factors that may be targeted to improve pathways in the future; and explores implementation metrics for both enriched and standard pain management to inform future scalability efforts. The research team aims to compare the effectiveness of two pain management pathways (standard vs. enriched) for patients undergoing lumbar spine surgery in the MHS, examine trial results in pre-specified sub-groups based on pre-surgical risk for persistent opioid use (high or low), and explore mediating effect of pain self-efficacy, catastrophizing, and hyper-vigilance on post-surgery opioid use and outcomes.

This study, conducted in collaboration with Brandeis University (overall PI), will advance knowledge on the military readiness and health status outcomes associated with different care trajectories that utilize non drug pain management strategies in active duty service members. The research team aims to characterize trajectories and outcomes of non-pharmacological therapy (NPT) utilization for pain management in active duty service members, identify facility- and provider-level factors that explain variation in NPT use and opioid prescribing for active duty service members between facilities, and describe the demographic, clinical and treatment history characteristics of active duty service members in the existing SUIPC cohort with chronic pain in the MHS who do and do not transition to VHA care; identify associations between NPT receipt in MHS and long-term health outcomes in the VHA (main effects); and identify selected moderators and mediators of these associations.

  • Lead Researcher: Krista Highland, PhD (krista.highland.ctr@usuhs.edu)

  • Outside Funding: NIH

  • Outcomes:

    • Bolton R, Ritter G, Highland KB, Larson MF. The Relationship Between Capacity and Utilization of Nonpharmacologic Therapies in the US Military Health System. BMC Health Services Research. In press.

    • Meerwijk EL, Adams RS, Larson MJ, Highland KB, Sox-Harris AH.  Dose of Exercise Therapy Among Active-Duty Soldiers With Chronic Pain is Associated With Lower Risk of Long-Term Adverse Outcomes After Linking to the Veterans Health Administration. Mil Med. In press.

    • Hodgkin D, Adams RS, Ritter G, Lee S, Highland KB, Larson MJ. Do Nonpharmacological Services Offset Opioids in Pain Treatment for Soldiers? Health Services Research. 2021.

    • Saadoun M, Bauer MR, Adams RS, Highland KB, Larson MJ. Opioid and Nonpharmacologic Treatments among Soldiers with Chronic Pain and Posttraumatic Stress Disorder. Psychiatric Services. 2021;72(3):264-272.

This study, conducted in collaboration with Brandeis University, will characterize and understand polypharmacy patterns and factors associated with polypharmacy in army soldiers who have returned from combat deployments. The research aims to identify among soldiers in a cohort treated for pain, those with high-risk medication use (HRM), using 4 military-relevant definitions. Additionally, the study aims to determine the distribution in the number of months of HRM in the year after first HRM, and characterize medication utilization within the 7 drug classes defining HRM, and determine the association of HRM with 5 indicators of adverse clinical outcomes (drug/alcohol overdose, suicide-related behaviors, unintentional injury, hospital admission, incident drug/alcohol diagnoses), each measured for the year following first HRM, using multivariable models controlling for pain characteristics and comorbidities.

This Congressionally Directed Medical Research Program - Chronic Pain Management Program-funded study is conducted in collaboration with the Walter Reed Army Institute of Research, with the intent to identify biopsychosocial markers of chronic pain maintenance and recovery/improvement. The researchers aim to identify biomarkers and psychosocial/behavioral factors uniquely associated with group membership (controls, maintained, improved), then explore their interrelationships, as well as biomarkers and psychosocial/behavioral factor changes uniquely associated with maintained versus improved group membership, then explore their interrelationships, and identify salivary biomarker correlates of plasma biomarkers associated with chronic pain maintenance and recovery/improvement.

  • Lead Researcher: Krista Highland, PhD (krista.highland.ctr@usuhs.edu)

  • Other USU Departments: Pathology

  • Outside Funding: Congressionally Directed Medical Research Program - Chronic Pain Management Program

This study will examine risks for negative post-surgical outcomes, as well as help pave the way for future efforts to identify and test therapeutic interventions. The research team aims to determine the biomarkers (microRNA, proinflammatory cytokines) associated with the presence (risk-related) or absence (resilience-related) of sleep dysregulation and pain prior to surgery, and determine the biomarkers associated with increases/maintenance (risk-related) and decreases (resilience-related) of sleep dysregulation and pain chronification after surgery. Through this research, not only can the findings be used to improve surgical outcomes, but also increase quality of life among service members and force readiness.

This study examines the impact of massage services embedded within a military treatment facility as standard of care in primary care. The research team aims to implement needs, processes, and effects of massage therapy integration. 

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Research Device
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Development
& Safety Pain Registry
Biobank Healthcare
Optimization Education &
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