Document Type

DNP Project

Department

School of Nursing

Date of Degree

Spring 2024

Degree

Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Mercedes Echevarria

Keywords

Program Evaluation; Federally Qualified Health Center (FQHC); Integrative Medical Group Visits (IMGV); Shared Medical Appointments (SMA); Chronic Pain; Opioid Use Disorder (OUD)

Abstract

Background: Chronic pain is a public health crisis. Current clinical practice guidelines recommend non-invasive mind-body therapies as a first-line treatment, and studies indicate they can be successfully delivered in group settings using an Integrative Medical Group Visit model. A Federally Qualified Health Center piloted a nurse-led Integrative Chronic Pain Group program for Medication Assisted Treatment patients experiencing chronic pain and opioid use disorder, for which an evaluation was needed.

Objectives: This evaluation examined program quality, value, and significance to provide a progress report toward established goals to inform stakeholder decision-making and improve effectiveness.

Methods: Following the CDC Program Evaluation Framework, the execution, cost- effectiveness, and impact of the program were evaluated through review of deidentified clinical and billing data, program and organizational documents, and stakeholder interviews and surveys. Conclusions and recommendations were generated from study findings.

Results: Quality measures indicated that program implementation and execution were mostly aligned with the original plan and many best practices. Value and sustainability indicators revealed slightly higher annual revenue than traditional individualized care. Paired pre-post biometric indicators detected a significant decrease (a = 0.05) in depression-related PHQ-9 scores (n = 3, p = 0.04), and a marginally significant decrease in systolic blood pressure (n = 5, p = 0.06). Patient and provider surveys indicated satisfaction with program execution and impact. Qualitative data found that peer support and group involvement were considered primary positive program impacts.

Conclusions: Though the power to identify significant program-related effects was limited by the lack of robust financial and clinical data and low power, the sample population did represent the target population so results may be generalizable within the organization. By increasing access to integrative chronic pain management for vulnerable patients at a safety net clinic, the program demonstrated feasibility, fidelity and the principles of value-based care: it positively impacted patient care, provider satisfaction, financial value, and clinical outcomes.

Keywords: Program Evaluation, Federally Qualified Health Center (FQHC), Integrative Medical Group Visits (IMGV), Shared Medical Appointments (SMA), chronic pain, Opioid Use Disorder (OUD)

Open Access

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