Patient-Centered Outcomes Research
Secondary Topic: Health Services Research/Cost Effectiveness
Tertiary Topic: Research Methodology
Patients Receiving Integrative Medicine Intervention Efficacy Registry (PRIMIER): A BraveNet Practice Based Research Evaluation Focusing on a Chronic Pain Cohort
Jeffery A Dusek, PhD; Donald I Abrams, MD; M. Diane McKee, MD; Rowena Dolor, MD; Ben E Kligler, MD, MPH, , New York City, NY, United States
Late Breaker: No
BraveNet is the first national integrative medicine (IM) practice-based research network (PBRN). PRIMIER is a prospective, non-randomized, observational evaluation conducted at 17 BraveNet sites. A main purpose of PRIMIER is to collect patient reported outcomes (PROs) at specified time periods across the entire BraveNet. A secondary purpose examines whether specific clinical populations (e.g. chronic pain) or IM interventions are associated with improved outcomes over time.
Participants received non-standardized, personalized, multimodal IM approaches for various medical conditions. Using REDCap, participants electronically consented and then completed Patient Reported Outcomes Measurement Information System (PROMIS)-29, Perceived Stress Scale (PSS-4), and the Patient Activation Measure (PAM) at baseline, 2, 4, 6, and 12 months. Extractions from participants’ electronic health records included IM services received, ICD diagnostic codes, and CPT billing codes associated with each IM visit.
Repeated-measures analyses were performed on interim data to assess change from baseline through 12 months. Through April 2017, 3,809 patients enrolled in PRIMER and 1,392 met the criteria for chronic pain. Pain participants were white (87%), female (77%) with a mean age of 49.6 (sd 14.6). On the PROMIS Anxiety, Fatigue and Pain Interference scales, our population reported elevated levels (0.5 SD) relative to national norms. Significant reductions were observed at the 12-month assessment on the all 7 PROMIS-29 subscales and across all 4 timeperiods (2, 4, 6, and 12-month) on Fatigue, Pain Interference, and Pain Intensity constructs. PSS-4 scores significantly improved across 3 of the 4 assessments (2, 4, and 12 month), whereas the PAM scores (which were already high at baseline) significantly increased at the 12-month assessment only.
To-date PRIMIER results indicate a profound improvement across all of the tested PROMs. Further analyses will provide insights as to whether specific IM interventions or combinations are associated with larger improved outcomes in the chronic pain cohort and other populations.