Digital Repository Doctoral Projects Spring 2022 Implementation of a Collaborative Healthcare Method into an Integrative Wellness Clinic for the Treatment of Acute Pain Suzy Heugly Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Heugly, S. (2022) Implementation of a Collaborative Healthcare Method into an Intergrative Wellness Clinic for the Treatment of Acute Pain. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. A Collaborative Approach to Treat Acute Pain by Suzy Heugly DNPc, APRN, FNP-C A project submitted in partial fulfillment of the requirements for the degree of DOCTOR OF NURSING PRACTICE or MASTER’S OF SCIENCE IN NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, Utah April 18, 2022 _______________________________ 4/18/2022_____________________ Student Signature (electronic) Date _______________________________ __________________________ Faculty Lead Signature (electronic) Date _______________________________ __________________________ Date Melissa NeVille Norton DNP, APRN, CPNP-PC, CNE A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 1 Implementation of a Collaborative Healthcare Method into an Integrative Wellness Clinic for the Treatment of Acute Pain Suzy Heugly Weber State University Annie Taylor Dee School of Nursing Doctorate of Nursing Practice Project Faculty Project Lead: Dr. Melissa Neville Project Consultant: Cathy Harmston Date of Submission: November 10, 2021 A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 2 Abstract Acute pain is a complex process and one of the most common reasons patients seek outpatient care by nurse practitioners and other healthcare providers. Many pain management approaches for acute care are available to adult patients, including medication, spinal manipulation, physical therapy, and specialty referrals. Typically, patients must see multiple healthcare providers and various clinics for treatment. For this project, a collaborative care model composed of a highly functioning, interprofessional care team was established to provide patients with advanced pain management therapies and personalized care management. A nurse practitioner-led care team, was also developed to ensure that patient care was personalized, collaborative, timely, and sustainable. When acute pain is managed correctly using a collaborative and interprofessional nurse practitioner-led approach, patients’ clinical outcomes and satisfaction reports are improved. Keywords: Pain, Collaborative Care, Standard Treatment, Complementary Treatment A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 3 Table of Contents Introduction ......................................................................................................................................5 Back Ground and Problem Statement ..........................................................................................5 Diversity of Population and Project Site ......................................................................................6 Significance for Practice Reflective of Rule-Specific Leadership ..............................................6 Literature Review and Framework ..................................................................................................7 Framework ...................................................................................................................................7 Search Methods ............................................................................................................................7 Synthesis of Literature .................................................................................................................8 Collaborative Care and Complementary Therapy for Treatment and Acute Pain ...............8 Collaborative Approach Benefits in a Clinic .......................................................................8 Healthcare Cost Benefits of Collaborative Care ..................................................................9 Barriers to a Collaborative Care Approach ........................................................................10 Pain with Injury..................................................................................................................11 Collaborative Model as a Solution .....................................................................................12 Discussion ......................................................................................................................................13 Implications for Practice ................................................................................................................14 Project Plan ....................................................................................................................................14 Project Design ............................................................................................................................14 Needs Assessment of Project Site and Population .....................................................................15 Cost Analysis and Sustainability of Project ...............................................................................16 Project Outcome Measures ........................................................................................................16 Ethical Considerations ...............................................................................................................17 Instruments to Measure the Effectiveness of Intervention ......................................................17 Project Implementation ..................................................................................................................18 Interventions ..............................................................................................................................18 Conflict Management.................................................................................................................19 Alignment of Intervention and Project Outcomes .....................................................................20 Project Time Line ......................................................................................................................20 Project Evaluation ..........................................................................................................................20 Data Maintenance/Security ........................................................................................................21 Data Collection and Analysis.....................................................................................................21 A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 4 Findings......................................................................................................................................22 Pre-Post Survey Results Comparison ................................................................................23 Pain Disability Questionnaires ...........................................................................................24 Limitations .........................................................................................................................25 Quality Improvement Disscussion .................................................................................................27 Translation of Evidence Into Practice ........................................................................................27 Implications for Practice and Future Scholarship ......................................................................29 Sustainability..............................................................................................................................30 Disemination ..............................................................................................................................31 Conclusion .................................................................................................................................31 References ......................................................................................................................................33 Appendix A. Table 1 ......................................................................................................................39 Appendix B. CSACD Survey ........................................................................................................40 Appendix C. Pain Dissability Questionaire ...................................................................................41 Appendix D. Table 2 ......................................................................................................................42 Appendix E. Simply Wellness Patient Flow Chart ........................................................................43 Appendix F. Google Chat for Colaboration ...................................................................................44 Appendix G. Red-Flagged & New Patients for Weekly Colaboration ..........................................45 Appendix H. Conduct Handout......................................................................................................46 Appendix I. Timeline .....................................................................................................................47 A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 5 Implementation of a Collaborative Healthcare Team Model in an Integrative Wellness Clinic With the difficulty of addiction-related to the national opioid epidemic (Dart et al., 2015), some healthcare professionals struggle to effectively treat their patient's acute pain. Treating acute pain with conventional and complementary treatments has positive outcomes. The purpose of this DNP Project is to develop a collaborative team approach in treating patients with acute pain by using conventional and complementary methods (Verhoef et al., 2006). Background and Problem Statement Treating acute pain with an injury can be a daunting task for many practitioners and their patients. Because pain is subjective, treating it is complex and unique for each individual (Williams & Craig, 2016). Unfortunately, an enormous number of people suffer from poorly treated acute pain that has transitioned to disabling chronic pain. Chronic pain has put a tremendous burden, especially financially, on the healthcare system and society. This burden, combined with rising healthcare costs and the opioid epidemic, makes it essential to discover and implement new ways to treat and manage acute pain, which the DNP Project addresses (Morley & Cashell, 2017). This DNP project will implement a collaborative team approach using coordinated care to treat and manage acute pain. Coordination is described as the partnership among various healthcare professionals and the patients and their families through collective decision-making, coordination of care, and collaboration on goal achievement (Dayhew et al., 2014). This philosophy of care includes the participation and utilization of specific talents from each team professional in a collective and harmonized manner while incorporating standard and complementary therapies to address acute pain. The promising outcomes tied to collaborative A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 6 care for the treatment of complex illnesses have caused this approach to gain momentum and, as a result, is revolutionizing the healthcare industry. The project aims to use the same system in addressing acute pain (Mior et al., 2010). Diversity of Population and Project Site Simply Wellness Clinic is a small integrative clinic in South Weber, Utah, that serves patients of all ages and nationalities. The majority of the patient population includes those suffering acute pain related to injuries. The clinic professionals practice both standard and complementary medicine, making this clinic an ideal place to incorporate a collaborative approach to treating acute pain (Verhoef et al., 2006). Processes exist to address diverse populations at the clinic. One of the providers is bilingual and speaks fluent Spanish. In addition, low-income or uninsured patients who cannot afford to pay can make payments on a reduced payment schedule. This structure is in alignment with addressing diversity within the community. Significance for Practice Reflective of Role-Specific Leadership There are several benefits of using a collaborative approach to treat patients. One significant advantage is that utilizing a collaborative team approach allows the knowledge and talents from a group of professionals to be accessed instead of relying on just one independent practitioner (Mayo & Woolley, 2016). A doctorate-prepared nurse practitioner's role is significant in that they can contribute by applying their healthcare-acquired skills and implementing leadership skills, such as managing each patient's care and function as the central care coordinator of the clinic (Nichols et al., 2014). A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 7 Literature Review and Framework This review aims to define acute pain related to injury and explore the possible solution of implementing collaborative care focused on treating acute pain in the general population using integrative medicine, including complementary and standard treatments. Furthermore, evidence will be examined to investigate affirmative outcomes and potential barriers that must be recognized to ensure that implementing collaborative care can be a sustainable change that improves patient care and strengthens the healthcare organization (Morley & Cashell, 2017). Framework This project uses the sustainability framework by The Board of Regents of Georgia's University System (2011). This framework has fourteen steps. At different stages of the project, eight steps are implemented, including strategic vision, collaboration, leadership, relevance and practicality, evaluation, communication, efficiency, and effectiveness. The strategic vision and collaboration include the interdisciplinary team offering complementary and standardized treatments to patients who experience acute pain. As a DNP leader, I oversee this change. Utilizing different team members in the same practice allows for relevance and maximum practicality as the patient can receive various treatments without going to several locations. Evaluation, communication, efficiency, and effectiveness will be accomplished by having 4, 8, and 12-week re-examination and collaborative meetings discussing patient progress and measuring the success or limitations of the overall treatment plan. The sustainability framework is ideal for my DNP project because it coincides with the concepts accomplished by this project. Search Methods Several articles regarding collaboration using conventional and complementary treatments were reviewed utilizing search engines that included CINAHL, Google Scholar, A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 8 EBSCO, Ovid, Science Direct, and Cochran Library. Search terms and keywords included collaborative care, standard treatment, complementary treatment, integrative medicine, and acute pain. Synthesis of Literature The following themes emerged from the literature review. They included (a) collaborative approach benefits in a clinic, (b) healthcare cost benefits of coordinated care, (c) barriers to a collaborative care approach, (d) consequences of poorly treated pain, and (e) the need for a better approach to treating pain. Collaborative Care and Complementary Therapy for Treatment of Acute Pain Collaborative care can be defined as a partnership between various healthcare professionals and their patients that utilizes shared decision-making, coordination of care, and evaluation of treatment (Morley & Cashell, 2017). This philosophy of care includes the participation and utilization of specific talents from each team member in a collective and harmonized manner while incorporating standard (conventional) medicine and complementary therapies to address the variety of complex illnesses plaguing society. Complementary treatment is defined as a non-mainstream practice used together with conventional medicine (NCCIH, 2018). Implementing complementary and standard treatments requires a collaborative care approach. The promising outcomes tied to collaborative care have caused this approach to gain momentum and, as a result, is revolutionizing the healthcare industry and treating acute pain (Morley & Cashell, 2017). Collaborative Approach Benefits in a Clinic Several benefits exist from using a collaborative approach to treat patients. One significant advantage is that utilizing a collaborative team approach, with the patient at the center A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 9 of the team, allows the knowledge and talents from a group of professionals to be accessed, instead of relying on just one independent practitioner (Mayo & Woolley, 2016). Placing the patient at the center of the care team can empower the patient, leading to improved patient satisfaction, decreased anxiety, and overall enhanced quality of life (Mervyn et al., 2019). Having various specialized team members in one facility benefits the patients and the providers. The patients benefit by having easier access, increasing patient compliance, and improving patient safety. The decrease in medical errors occurs when collaboration is solid and teams work harmoniously to evade gaps in quality assurance measures, thus improving safety (Morley & Cashell, 2017). The benefits of collaborative care are not limited to the patient; they can also extend to the provider. Burnout has climbed to considerably high levels among providers of healthcare. Over 50% of physicians and 30% of nurses have symptoms of burnout, which is detrimental to patient care and contributes to provider shortage. This methodology can decrease provider burnout while providing a more appropriate and viable work/life balance (Reith, 2018). Healthcare Cost Benefits of Collaborative Care The present emphasis on decreasing the rising health care costs while simultaneously improving the quality-of-care places added pressure on healthcare organizations. Research shows that a collaborative care approach can help with this dilemma and reduce cost by (a) decreasing hospital stays, (b) reducing overwriting of prescriptions, (c) increasing quality audit scores, and (d) improving general symptoms (Morley & Cashell, 2017). A randomized controlled trial was conducted by Unûtzer et al. (2008) to determine the effects on total healthcare costs when patients have access to collaborative care. The findings showed that participants (n =<0.1) had A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 10 lower mean total healthcare costs (M = $32, 785, 95% CI [$27, 648-$37, 921] than usual care patients during four years. This evidence supports that collaborative care is associated with lower overall healthcare costs than standard care (Unûtzer et al., 2013). Barriers to a Collaborative Care Approach A collaborative care approach in medicine is still relatively new to healthcare. This innovation can present barriers to effective healthcare delivery and sufficient insurance coverage, especially when complementary therapies are combined with standard treatments. Collaborative care being so new makes applying an established framework, such as sustainability, somewhat elusive and challenging to carry out (Milden & Stokols, 2010). Besides healthcare delivery and insurance coverage, providers lack the knowledge of collaborative approaches to complementary and alternative medicine (Johnson et al., 2013). Johnson et al. (2013) conducted an online survey among health educators (n = 1, 299) to examine their knowledge of complementary medicine using a 16-item CAM-knowledge scale 𝛼= 0.71. They discovered that participating health educators had a knowledge deficiency about collaborative approaches to complementary medicine and that definitions and terms needed to be more standardized. This lack of knowledge, coupled with the attitudes and biases of some physicians, can contribute to the underuse of collaborative medicine. Medical providers play a central part in regulating patients' ideas about collaborative care and the use of complementary treatments (Milden & Stokols, 2010). These biases would necessitate a paradigm shift that encapsulates the provider within the framework of a successfully functioning collaborative team (Saba et al., 2010). Although exceptions and recommendations for this type of practice are A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 11 gaining validity and recognition in the last decade, there is still much ground to cover in narrowing this view (Dayhew et al., 2014). Pain with Injury Description. Injury can be defined as the structural and functional debilitations produced by applying exterior forces to the body, causing acute pain and possible demise (Richmond et al., 2002, p. 215). The incidence of injury in the United States is relatively high. According to the Centers for Disease Control, approximately 2.8 million people are hospitalized every year due to injuries. In addition, there are 27.6 million people who are treated in an emergency department for injuries, while 214,000 people die from their injuries (Centers for Disease Control and Prevention [CDC], 2015). It is crucial to treat pain related to an injury when considering its prevalence. Pain is described as a traumatic experience associated with “actual or potential” damage to the body involving physical, neurological, emotional, and social factors (Williams & Craig, p. 2410). Acute pain is considered a physiological response to a negative biological or mechanical stimulus correlated with surgery, trauma, or disease process (Carr & Goudas, 1999, p. 2051). In addition to this, the pain experience is subjectively different among all human family members. Therefore, the patient needs to be treated individually, with the perspective of other healthcare professionals combined. Treatment based on the individual with multiple healthcare perspectives is why using a collaborative approach framework can be a more successful treatment of acute pain while limiting unfavorable long-term effects. Consequences of Poorly Treated Pain. When treating pain with injury, it is imperative to treat acute pain as early as possible; if not, its risk of developing into chronic pain, lasting three months or longer than the expected duration of tissue healing, is increased. The A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 12 management of acute pain originated over 40 years ago as providers established acute pain services and are currently a selected component of medical practice. Although there are widespread methods to treat pain, the primary approach has been analgesic, such as opioid medications (Carr & Goudas, 1999, p. 2051). The CDC reports that in a large number of adults in the United States, 5.7% used one or more prescription opioids within 30 days (Hales et al., 2020, para. 2). Furthermore, evidence indicates that 18.8% of Medicaid beneficiaries filled an opioid prescription during 21 months (Janakiram et al., 2019, p. 367). This narrow treatment plan of using a single provider with an opioid approach has led to the current opioid epidemic (Hales et al., 2020, para. 2). The high costs of the opioid epidemic are not the only fiscal nuances to consider with poorly treated pain. According to a CDC report, one-fourth of all adults residing in the United States have some sort of disability that majorly impacts their lives which calculates to 61 million Americans. Of that 61 million, many of them have disabilities related to poorly treated pain receiving government-supported benefits (Center for Disease Control, 2018). Furthermore, citizens with uncontrolled and poorly treated pain have more frequent, and extended hospital stays paid for by government-funded medical programs like Medicaid and Medicare. Besides issues such as chronic pain, the opioid epidemic, and the financial burden of poorly controlled pain, other consequences include, but are not limited to impaired function or disability, prolonged recovery, and decreased quality of life. Therefore, establishing complementary therapy regimens to treat pain is more pressing now than ever (Lyndon & Cashell, 2017). Collaborative Care Model as a Solution Thielke et al.'s (2015) study substantiates the need for collaborative care as part of the treatment approach for pain intensity, pain interference, and depression. The study found both A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 13 symptom improvement and sustained reduction of chronic musculoskeletal pain and depression in Veterans as evidenced by (n = 401). Collaborative care can improve outcomes and provide sustainable changes because collaborative care embodies a diverse treatment plan that addresses the physical, sensory, emotional, cognitive, and social facets of the pain experience while providing healing to the whole patient (Dayhew et al., 2014). Although several collaborative care models are considered, it is essential to focus on each aspect to facilitate a successful approach to treating acute pain (Johnson et al., 2014). Discussion Collaborative care can be an innovative way of treating acute pain. Using a multi-faceted approach can provide multidimensional interventions coupled with collective forms of thinking to produce a more holistic approach when treating acute pain (Mior et al., 2010). The evidence also confirms that having a solid framework with a cohesive team is fundamental and can have a tremendous impact on the quality and sustainability of treating acute pain while also lowering healthcare costs (Bower et al., 2018). Evidence of this research is supported by a cohort study performed at the University in Nebraska, where it was found that they could improve patient outcomes and lower the cost of care in an ambulatory care center by implementing an interprofessional collaborative practice model (IPCP). The study results showed that IPCP implementation was associated with absolute reductions of 16.7% in emergency department visits, 17.7% in hospitalizations, and 48.2% in total patient charges. More importantly, the benefits of improved health outcomes and cost reductions. are in keeping with the triple aim associated with U.S. health care reform (Guck, 2019). A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 14 Implications for Practice Healthcare providers are responsible for initiating and advocating for change as we act as ambassadors for our community's health through innovation and best practices. By participating in a collaborative healthcare model, the provider can find fulfillment as they witness the patient find relief from pain while engaging in a proactive approach of self-care that promotes disease prevention and health maintenance (D'Amour et al., 2005). In addition, a collaborative care approach in treating acute pain extends beyond the practice setting to the general population as the opioid epidemic continues to become a paramount issue plaguing the nation. During the last 20 years, there has been a substantial increase in pain treatment with opioids as a monotherapy treatment (Hales et al., 2020). Employing a collaborative healthcare model using complementary and standard therapies can help to reduce the effects of the opioid epidemic, which has inundated our society while simultaneously causing health care costs to skyrocket (Manchikanti et al., 2012). Project Plan Project Design The type of quality improvement design for my DNP Project is based upon process improvement. According to Bastian et al. (2016), our Nations's healthcare is “spiraling out of control” because of astronomical costs and the lack of available, efficient, quality care (e39). Process improvements must be designed and implemented to get better results. A single care provider approach to pain management is not producing satisfactory results, as evidenced by the opioid epidemic plaguing or country (D’Amour et al., 2005). This DNP Project design will implement a communication system to create a collaborative team approach using conventional medicine with complementary treatments to A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 15 manage acute pain. A collaborative healthcare team is structured with qualified members who understand their roles and execute their duties efficiently and capably. The role description of each healthcare provider is as follows: • The chiropractor performs the initial scouting exam and determines the need for further treatment. • The medical Provider/care coordinator completes the initial medical assessment, establishes the need for further treatment, provides referrals, and coordinates patient care. • Neurological Specialist for motor vehicle occupant and acute injuries conducts a specialty exam, if needed, and recommends treatment. • Certified exercise and mobility therapist executes an initial physical functioning assessment and facilitates individualized rehabilitation treatment plan as directed. • Certified massage therapist delivers soft tissue treatment. Needs Assessment of Project Site and Population When evaluating the needs regarding the project site and population, it is essential to address social determinants of health and diversity considerations. The specific determinant that is most likely to influence health disparity among the selected population is many low-income citizens living in Weber County, leading to underinsured and uninsured residents. The unemployment rate is higher in Weber County at 3.0% compared to the Utah average of 2.6%. The uninsured residents of Weber County are at 10% compared to neighboring Davis County at 7% (County Health Rankings & Roadmaps, 2021). A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 16 Simply Wellness Clinic is a small clinic in South Weber, Utah, that serves patients of all ages and nationalities. The low-income or uninsured patients who cannot afford to pay are offered a reduced payment schedule, promoting social justice within the community's at-risk population. Cost Analysis and Sustainability of Project This project has no direct budgetary requirements as it does not require any monetary resources. However, an approximate number of employee hours needed to complete the project are presented (see Appendix A). In addition to the low budgetary requirement of this project, incorporating a collaborative care model composed of a highly functioning team, an accurate assessment, and a well-developed treatment plan can improve patient outcomes and enhance the quality of life. Most importantly, collaborative care can prove to be a sustainable change that strengthens the healthcare structure and improves population health (Mior et al., 2010). Project Outcome Measures Phase I includes implementing the care plan comprised of the conventional and complementary treatments structured by the collaborative care team from the assessment and information gathered at the initial examinations. At the four-week interval, the medical provider will reexamine the patient, and the patients’ needs will be assessed, and cumulative Pain Disability Questionnaires reviewed. A collaborative team meeting will occur, and the care plan may be modified as needed to optimize patient outcomes and healing. Intermediate focus outcomes will be a Phase II, 8-week re-examination where the patient and the recovery progress will be evaluated. Pain assessment scores will also be reviewed at a collaborative team meeting to appraise the effectiveness of the treatment plan. At this time, the A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 17 care plan will be modified to accommodate specific barriers that may arise. Long-term outcomes will be measured at Phase III; a 12-week examination that includes patients’ Pain Disability Questionnaire results will be reviewed to determine if acute pain has improved significantly. The outcome should be that the patients’ pain level is close to the pre-injury or baseline state. If not, a collaborative team meeting will occur with a reevaluation of the care plan and modifications as needed. The new treatment plan will be set for another four weeks, or if the collaborative team deems that referral for chronic pain management is the best course of action, it will transpire at that time. Ethical Considerations Ethical considerations must be taken into account when implementing a quality improvement project. The following items outline the actions: • The Institutional Review Boards of Weber State University (IRB-AY20-21-389 – June. 25, 2021) reviewed and approved the project. • Measures were implemented to support ethical considerations of the Pain Disability Questionnaire, such as removing all patient identifiers and keeping them on a secure computer hard drive. • The Collaboration and Satisfaction About Care Decisions (CSACD) survey given to the collaborative care team will be anonymous and stored in a locked file drawer. Instruments to Measure the Effectiveness of Intervention Instruments used to evaluate the effectiveness of the collaboration team meetings and pain improvement in patients are critical to the project’s success. The Collaboration and Satisfaction About Care Decisions (CSACD) survey was selected (see Appendix B) to measure A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 18 the success of the collaboration meetings. This survey will be reported using aggregate data, keeping responses anonymous and confidential. Data will be used to ensure that each team member is actively engaged and fully utilized in planning patient care. The Pain Disability Questionnaire (PDQ) instrument delivers a numerical scale format to ascertain how pain affects the patients' function in activities of daily living (see Appendix C). Tracking the data at the initial, 4, 8, and 12-week exams establishes if the collaborative care team's treatment plans reduced the acute pain the patients are experiencing (Anagnostis et al., 2004). Project Implementation Interventions This project aims to use a collaborative approach to treating acute pain. This approach includes standard and complementary treatments (see Appendix D) by the collaborative care team. The team uses the following tools to collaborate: • The flowchart describes the process and patient flow from entry to exit (see Appendix E). • The collaboration team uses Google Chat for daily communication and collaboration methods (see Appendix F). • The Red Flagged and New Patient form helps the team collaborate on new patients and patients struggling to meet expected outcomes. These outcomes include patients having had four consecutive appointments without any improvement in pain symptoms and those who are not compliant with medication, rehabilitation exercises, and referral appointments (see Appendix G). The PDQ measures collaborative approach effectiveness in treating patients with acute pain. Four benchmark collaboration meetings occur throughout the treatment process. The 1, 4, A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 19 and 8-week benchmark collaboration meetings focus on the patients’ progress in improving their acute pain scores and treatment plan. If the pain is not improving, the care team will modify the treatment plan through collaborative efforts utilizing additional standard and complementary interventions. If the patients' scores improve, the current treatment plan will continue with minor modifications as needed. If the scores do not improve, the care plan is revised by scheduling further referrals as needed and reevaluating the patients’ progress at the final 12-week collaboration meeting. Suppose the patients’ acute pain is not improving significantly by the 12-week collaboration meeting. In that case, the team will refer the patient to a chronic pain clinic for further evaluation and treatment as necessary. For a collaborative approach to be successful, each care team member must contribute to the patient care plan and feel that their ideas are being heard and utilized. The CSACD survey measures the collaborative efforts of the group. After each team collaboration meeting, the group will examine the tool results at weeks 1, 4, 8, and 12. Suppose the CSACD results reflect negative feedback or show that team members feel that their ideas and decision-making responsibilities for the patient(s) were not shared. In that case, the group will have a follow-up meeting to address the issue(s). Conflict Management Conflicts are common within the interpersonal context of teams and management of those conflicts can have a substantial impact on team dynamics and overall outcomes (Merrritt & Kelley, 2018). Research has indicated that it is not merely the manifestation of a conflict that affects teams; rather how team members approach and manage these conflicts has an extensive impact upon whether the conflict is constructive or destructive (Deutsch, 1994). It is also essential that collaboration meetings be conducted professionally. Team members should be A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 20 assured that they are in a safe environment and their ideas are valued. Having set guidelines and clear boundaries can be a key element in effective teamwork and conflict management (Somech, 2009). A handout with guidelines of appropriate language and behavior will be provided to participants at these meetings to ensure there is an innocuous environment that encourages contributors to share without fear of retribution (see Appendix H). Alignment of Intervention and Project Outcomes The overall outcome for this project is to reduce patients’ acute pain using standard and complementary treatments with a collaborative team approach. The interventions presented and the tools utilized to align with this outcome. Furthermore, the collaborative care team comprises qualified individuals capable of treating patients with acute pain to achieve quality outcomes. Project Timeline The DNP Project processes range over six semesters. The timeline for this project is broken down into four phases: (a) phase one involves preparation and design; (b) phase two establishes the implementation of the project; (c) phase three includes evaluation, and (d) phase four encompasses the completion and dissemination of the project (see Appendix I). Project Evaluation A fundamental part of an evidence-based approach to practicing medicine is to evaluate the outcomes of a study and determine its applicability. Evaluation processes are an integral component of quality improvement projects because they a) help to identify issues that may arise with the project, b) monitor the impact of the project, and c) assist in collecting more accurate information as part of a future evaluation project (Harvey & Wensing, 2003). This DNP project incorporated an implicit quality improvement design using a pre-post technique, in which observations were made before and after each intervention over a three-to-six-month period. By A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 21 appraising these observations after each intervention, it provides clinicians with a valuable tool to determine the applicability of the study. Understanding and further utilizing this information demonstrate the value and impact of the project (Haass & Guzman, 2020). The project's outcome is to use the evaluated results as an evidence-based approach to implementing a collaborative team model for managing acute pain that includes standard and complementary therapies in other settings. Data Maintenance/Security Maintaining security with the data collection process was of the utmost importance throughout this project. Results from the Surveys (CSACD) tool were strictly confidential. The researcher provided an email link to participants to complete the survey. Qualtrics stored the results without any identifiers except the date and time. Data Collection and Analysis The quantitative data were collected using a Qualtrics Survey Tool. The survey included eight modified questions from the CSACD survey to gather responses regarding a specific clinic setting to obtain more quality data. A Likert scale was used for each question, measuring data points that began with 1 (strongly disagree) and ended with 7 (strongly agree). The survey instrument was then distributed twice to respondents using a pre and post-test methodology. Participants were provided with instructions for completing the surveys, including informed consent and an option to opt-out of the clinical quality improvement intervention. In today’s health care environment, there is an increasing focus on the quality of care delivered by providers in acute pain management (Carr & Goudas, 1999). One such method to improve quality care in this area is incorporating a team approach using a collaborative process for patient care. This project was designed to test the hypothesis of using teamwork and A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 22 interprofessional collaboration to improve outpatient clinical services for treating acute pain. A pre-post assessment design was used to compare changes in the targeted outcome of a QI intervention before and after the project intervention. Initially, an anonymous online pre-assessment using the CSACD survey instrument was provided to the interprofessional team through Qualtrics. A mixed-methods approach for data collection was used by collecting and analyzing quantitative data from the survey questions. There is a need for clinicians to incorporate QI practices as a standard component of their daily clinical operations (Grol, et al., 2007). As such, additional data was collected during working group-team meetings a 4, 8, and 12-weeks. Data obtained from participant responses will be reported as a frequency distribution in a future publication. Future reporting of the additional data points enhances the ability to determine whether changes that occurred resulted from the interventions introduced and dramatically strengthens the evaluative approach compared to aggregated before and after data (Wong & Sullivan, 2016). In conclusion, the design of the project aligned with the project outcome goal for improving patient care using a collaborative method. Findings Data collection and reporting is an essential part of QI project implementation (Grol, et al., 2007). The data results were sorted within the Qualtrics, and the statistical measurements of central tendency were obtained on each question. The statistical results were compared, contrasted, and summarized in Table 1. Mean and standard deviation are frequently used measures of central tendency and variability in data (McGrath et al., 2020). Examining the mean and standard deviations with each question was an effective way to comprehend how team members felt about the collaboration process in general. The intended outcome of this project A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 23 was to determine if implementing a collaborative approach within an interprofessional care team using standardized and complementary interventions to treat patients’ acute pain would constitute improved results. More specifically, the intent was to establish a cohesive method that supported collaboration among team members so that highly effective care plans could be created and utilized to optimize patient care and improve patient outcomes. The findings demonstrated by the increased satisfaction scores of the post-assessment survey that the projects team met this outcome. Each question in the table measured respondents' satisfaction using a Likert scale both pre-introduction and post evaluation. There was significate improvement in the satisfaction of respondents after using a collaborative method to treat patients with acute pain, as shown by the differences between the mean value for both pre-and post-surveys. This information is crucial because it shows how a collaborative method was used successfully in a live patient clinical setting with potential application in a larger healthcare setting. Pre-Post Survey Results Comparison When examining the findings of the pre-assessment survey, it is clear that there is a significant gap in the discussion making process for patients receiving treatment at the clinic regarding effective teamwork and collaboration. The mean score of all eight questions regarding satisfaction in teamwork and collaboration before the quality improvement project was significantly lower than the mean score post-project utilizing the CSACD collaboration tool. The highest mean on the pre-survey was 3.25 compared to the highest on the post-survey of 6.50. Furthermore, when comparing the lowest mean result of the pre-survey of 1.75 and the post-survey of 6.0, it is clear that there was a significant increase in collaboration among team members. A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 24 Pain Disability Questionnaires Disability evaluation is an essential aspect of clinical care when treating patients with acute pain. Pain Disability Questionnaires (PDQ) are often used for assessing a patient’s perception and progress of their disability concerning pain (Anagnostis et al., 2004). This study incorporated the usage of a similar PDQ, which was administered to patients at the initial, 4, 8, and 12-week exams to assess patients’ perceptions of pain. The generalized information was collected by patients filling out the questioners at the beginning of the exam appointments. The practitioner then reviewed the results with the patient for clarification and understanding. Analysis of the data found that patients’ perceptions of pain improved with the intervention of the collaborative healthcare team approach during each week interval. Information collected from the existing PDQ questionnaires will serve as a valuable tool when revisited at a future date where a more comprehensive chart review can be performed. The PDQ questionnaires are currently kept in a locked file. It is intended to expand the research project with a full IRB involvement and approval to further assist in improving the collaboration model. Table 1 Scores on Pre and Post Collaboration About Care Decisions Survey CSACD questions Pre-assessment n=4 Post-assessment n=4 How satisfied are you with; M SD M SD 1. Team members planned together to make decisions about care for patients? 2.25 .43 6.00 .71 A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 25 2. Open communication among team members took place as the decisions were made? 1.75 .43 6.00 .43 3. Decision-making responsibilities for the patients were shared among team members? 2.00 .71 6.50 .50 4. Team members cooperated in making the decisions? 2.50 .50 6.00 .71 5. In making the decisions, all team members’ concerns about the patient’s needs were considered? 3.25 .83 6.25 .83 6. Decision-making for the patients was coordinated among team members? 2.00 1.00 6.25 .43 7. How satisfied are you with the way the decisions were made for the patients? 2.00 0.71 6.25 .43 8. How satisfied were you with the decisions made for these patients? 3.25 1.30 6.50 .50 Limitations The manifest function of the identified intervention is to incorporate a collaborative approach using standard and complementary therapies to treat acute pain. There are possible latent functions using this type of intervention that may inhibit the success of collaborative intervention. One such unintended consequence includes patient risk for not receiving adequate treatment without a standard protocol for correct intervention. Standard protocols must be carefully examined, and objectives critically analyzed before procedural implementation. A research design using a survey tool to collect qualitative data can present various limitations. Some weaknesses include; a) surveys using closed-ended questions can have a lower A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 26 validity rate than other types of data, b) the question-answer options can be interpreted differently by respondents based on their idea of what the choices mean, which can lead to unclear data, and c) respondents may not want to provide answers the show themselves in an unfavorable manner even if the results are anonymous. However, the main weakness of this study was the small sample size. Survey results cannot be generalized to a larger population because of the small sample size. However, these results are valuable because it provides a reasonable survey instrument for additional research on a larger scale. The research team recommends using the CSACD survey instrument for further research on this topic (Hackshaw, 2008). Balancing measures are the metrics a health system must track to ensure that an improvement in one area isn’t negatively impacting another (Aron, et al., 2019). There are possible balancing measures that may help to mitigate such limitations. First, it will be necessary to expand a review of possible standard protocol models using a collaborative approach for patient intervention that might exist outside regional and national purviews. A more detailed and thorough investigation of health care facilities on a national level may reveal collaborative approaches to patient care. Comprehensive searches of European and other world health care facilities might also uncover qualified models already in use. Such information would be invaluable to help balance the identified limitations of an unproven model and the lack of standard collaborative protocols, which would assist in guarding against creating new problems and help ensure that the QI intervention improves care. A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 27 Conclusion Providing evidence-based services to patients using a team-based approach is imperative for patients seeking services for acute pain. The purpose of this QI project was to determine if a collaborative team approach using coordinated care among healthcare professionals is successful in treating patients with acute pain. A method for professional collaboration was chosen and introduced to four health care professionals at a local patient care facility. The survey instrument CSACD was used to identify respondents' perceptions regarding the success of collaborative meetings both pre-and post-use of the collaboration model. It was found that the health care team respondents to the CSACD survey showed increased satisfaction with implementing a collaborative process for treating patients with acute pain at Integrative Wellness Clinic. Research transferability invites practitioners to connect the outcomes of this study with their own experience. Such transferability may allow for measured performance improvements at other health care locations using a similar or varying model for collaborative patient care. Quality Improvement Discussion The promising outcomes tied to collaborative care for treating complex illnesses, including acute pain, continue to improve patient results and advance treatment options. Incorporating a collaborative care model composed of a nurse practitioner-led collaborative health care team that includes personalized assessments, well-developed treatment plans, and timely referrals can improve patient outcomes and enhance patients’ quality of life. This collaborative, thoughtful approach may yield the best promise for patient treatment and lead to a more informative, superior method for measuring patient progress (Verhoef et al., 2006). Translation of Evidence into Practice Evidence-based practice is a clinical decision-making process whereby clinicians use A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 28 current best research evidence to improve service delivery (Sackett, 2000). Literature reviews are often the first step in finding evidence-based approaches to inform professionals of the best available data to make healthcare decisions (Grant, 2009). This project, therefore, began with a comprehensive literature review of collaborative approaches for patient treatment as a way to provide quality patient care and improve patient outcomes. This collaborative theme appeared several times in the literature and provided a foundation for project development. It further assisted in invalidating the reason for moving forward with the intent to provide evidence-based results to drive quality improvement decision-making in health care settings (Cowell, 2015). It is expected for healthcare providers to commit to and prioritize evidence-based care in their professional practice. Establishing and leading health care environments that focus on open communication is also essential when accelerating engagement with evidence-based practices. There is an overwhelming consensus that evidence-based practice can improve outcomes for people using health care services (Tansella & Thornicroft, 2009). Objectives for this project sought to engage a health care team to gather evidence-based support of a collaborative model using open communication as an approach for patient treatment. The data showed that applying a collaborative approach to patient care and utilizing an inter-professional team resulted in higher quality care, decreased patient pain symptoms, and yielded greater staff and patient satisfaction. Although small in scope, the results of this project provide evidence-based information that can be used to prioritize patient care other professional practices. The promising results of this project have gained new knowledge. When practicing collaboration methods beyond patient care to an overall culture of inclusivity, including open communication, the project found that increased organizational efficiency resulted, and all healthcare team members felt valued and A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 29 became more productive. Implications for Practice and Future Scholarship It would be beneficial for researchers to engage in a more comprehensive study that incorporates collaboration methods at an institutional level to gain further insight regarding the successful treatment of patients with acute pain. This project has provided a foundation for practice and future research opportunities. Expanding this project model to a larger setting with more extensive involvement, a larger patient sample, and the collection of more detailed data resulting from healthcare professional collaboration can yield further valuable information. Interested health care practices also can use project outcomes as additional evidence-based support to prioritize their collaborative approach or model for patient treatment. The findings from this project demonstrate the value of incorporating collaborative models for managing acute pain in an outpatient setting. There is also an implication for other success beyond this project's scope. As health care providers collaborate with patients and incorporate an additional element for treating acute pain, they encourage patients to take a proactive approach for self-care that promotes disease prevention and health maintenance (D’Amour et al., 2005). Employing a collaborative healthcare model using inter-professional collaborative practice may also improve patient outcomes and have more significant implications for enhanced patient treatment in other related areas of healthcare. A collaborative care approach for treating acute pain could indeed assist in reducing the effects of the opioid epidemic (Manchikanti et al., 2012). Subsequent evaluation of this proposed model is necessary to determine if such crossover applies to adjusting standard therapies for treating complex illnesses and incorporating a collaborative approach to patient care. A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 30 Sustainability The literature suggests maintaining a sustainable change that quality improvement ingenuities need to become the enhanced way of accomplishing things rather than simply adding a small addition to regular clinical care. Most importantly, all stakeholders must understand or “buy-in” to why this change is essential (Silver et al., 2016, p. 916). Unless stakeholders can see the demonstrated benefits of change before full-scale implementation, most organizational change will not be maintained (Stauffer, 2008). The healthcare team in this project was able to gain complete buy-in due to quality improvement advancements and project success. Organizational change within this specific project setting will most likely lend itself to future sustainability. Another component of sustainability for the long-term success of improved patient care is the need to monitor and control healthcare treatment activity (Clemente et al., 2016). The healthcare team implemented process controls in this project as an essential part of maintaining quality and improving long-term performance and sustainability. Evaluating new patient treatment methods as a team during weekly meetings allowed stakeholders to monitor and adjust the project framework and access the value of patient treatment. Meetings at regular intervals also promoted opportunities to anticipate problems, review care plans, and support a culture of inclusion and cohesiveness. In addition, an essential constituent of process controls involves the implementation and review of patient flowcharts. Flowcharts for this project provided a visual outline of current best practices to help ensure changes improved patient outcomes and were consistently and reliably applied to every patient encounter. This visual management tool is simple to follow and permits transparency, thus allowing every staff member to distinguish normal from abnormal systems A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 31 promptly. Dissemination The dissemination of quality improvement (QI) findings is an integral part of the DNP project and QI process (Wong, 2016). Several ways are available to disseminate the findings of this DNP project. Incorporating the results of this DNP project into a broader study as mentioned will aid in enhancing and supporting these findings. The project team intends to submit the study for publication in a national scholarly journal. There are plans to present these project findings at national conferences and meetings of professional associations. Furthermore, the team plans to introduce the material through social media by creating an organizational website. Conclusion Acute pain is a complex process that can lead to poor outcomes, and therefore it is imperative to utilize methods that can produce effective results. The framework developed in this study used interprofessional collaborative practice between nurse practitioners, chiropractors, and other healthcare professionals in a primary care setting to treat patients’ acute pain. Results showed significant improvement in provider satisfaction with collaboration methods that improved their patients' pain levels. This study also demonstrated that multidisciplinary teams could be more proficient, productive, innovative, and superior risk management than a single provider approach. Furthermore, this study showed that using a collaborative, interprofessional team supports high-quality, safe care, increases staff satisfaction, and promotes organizational efficiency and innovation (Morley & Cashell, 2017). 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Updating the definition of pain. The Journal of the International Association for the Study of Pain, 157(11), 2420-2423. https://doi.org/10.1097/j.pain.0000000000000613 A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 39 Appendix A Table 1 Approximate Number of Employee Hours Necessary to Complete the Project Over Twelve Weeks CATEGORY HOURS Employee Orientation/Training 8 Weekly Collaboration Meetings 25 Weekly Meeting with Manager 20 Four Week Evaluation Meeting 4 Eight Week Evaluation Meeting 4 Twelve Week Evaluation Meeting 4 Chart Audit/Evaluations (Pain Score) 15 Ongoing Coordination 20 Total 100 A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 40 Appendix B Collaboration and Satisfaction About Care Decisions (CSACD) The following is an online survey that takes approximately 5 minutes. The survey questions will be about collaboration and satisfaction with care decisions (CSACD). Your responses to the questions will be confidential, and no identifying information will be collected, such as your name or email. The results of this survey will be reported using aggregate data, keeping responses anonymous and confidential. Data will be used for educational purposes to improve the content. If you have any questions, please contact susanheugly@weber.edu. Please circle the number that best represents your judgment about the team process and the decision. 1. Team members planned together to make the decision about care for this patient. 1 2 3 4 5 6 7 Strongly disagree Strongly agree 2. Open communication among team members took place as the decision was made for this patient. 1 2 3 4 5 6 7 Strongly disagree Strongly agree 3. Decision-making responsibilities for this patient were shared among team members. 1 2 3 4 5 6 7 Strongly disagree Strongly agree 4. Team members cooperated in making the decision. 1 2 3 4 5 6 7 Strongly disagree Strongly agree 5. In making the decision, all team members’ concerns about this patient's needs were considered. 1 2 3 4 5 6 7 Strongly disagree Strongly agree 6. Decision-making for this patient was coordinated among team members. 1 2 3 4 5 6 7 Strongly disagree Strongly agree 7. How much collaboration among team members occurred in making the decision for this patient? 1 2 3 4 5 6 7 No Complete Collaboration Collaboration 8. How satisfied are you with the way the decision was made for this patient, that is, with the decision-making process, not necessarily with the decision itself? 1 2 3 4 5 6 7 Not Satisfied Very Satisfied 9. How satisfied were you with the decision made for this patient? 1 2 3 4 5 6 7 Not Satisfied Very Satisfied Adapted, with permission (2021). A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 41 Appendix C A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 42 Appendix D Table 2 Standard and Complementary Interventions Intervention/Treatment Goal Medications Manage pain and inflammation to improve compliance with ADLs and rehabilitation exercises. Rehabilitation Exercises/Physical therapy Strengthen the weakened and damaged structures, restore balance, and improve range of motion (ROM). Chiropractic Adjustments Restore segmental and global (ROM), Increase proprioceptive feedback, and decrease pain. Electrical Stimulation (E-Stim) Decrease muscle spasms and decrease pain. Acupuncture Manage pain and stress/anxiety. Massage Therapy/Soft Tissue Manipulation Reduce muscular tension, improve tissue healing, increase lymphatic drainage, and decrease inflammation. Nutrition/Supplements Support the healing process and restore optimal biochemical balance Journaling Track patient symptoms, progress, barriers, reflection, and overall well-being Patient Education Ensure patient understanding of diagnosis and benefits of the treatment plan. Involve patients as the center of the care team and empower them to have an active role in their care. Mental Health Counseling Manage anxiety and depression related to injury and pain. A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 43 Appendix E (Heugly, 2021) Simply Wellness Patient Flowchart Preliminary Exam-Dr. Richens Cursory assessment for level of injury regarding musculoskeletal injuries, neurological injuries and imaging needs using patient SOAP note. Yes No Does patient need further evaluation? Follow Basic Tx. Plan with Dr. Richens Specialty Neurology Exam-Dr. Sequoia Earle DC -Evaluation of neurological findings using SOAP note. -Alterations to treatment plan as needed. Medical Exam-Suzy Heugly NP -Medical assessment -Coordination of care -Referrals as needed -Nutrition/ Supplements -Anxiety screening -Depressioon screening Collaboration and design of treatment plan between Dr. Richens, Dr. Earle and Dr. Heugly Conventional & Complementary Interventions -Prescription medications -physical rehab -massage therapy -chiropractic adjustment -nutrition/supplements -Acupuncture -electrical stimulation -pin-point injections Patient Evaluation & Collaboration -Weekly collaboration meetings using Red Flag & New Patient Collaboration Form -Check point meetings @ 4, 8, 12 weeks using chart audits regarding Pain Disability Questionnaire and CSACD Tool -Refer out for chronic pain management after 12 weeks. A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 44 Appendix F Google Chat for Daily Collaboration The collaboration team uses the Google Chat tool for daily communication and collaboration methods. This tool is a private, protected way to use real-time communication between providers to collaborate on patients' needs. Some examples below show how this tool facilitates daily collaboration to improve patient safety and maximize quality patient care. Examples: • The medical provider (myself) is with a patient for a follow-up visit, and there has been a change in a medication that I would like the other providers to be aware of. I send a Google Chat to our private group notifying them of this change. • One of the providers is with a patient, and the patient reports that they are starting to experience PTSD, anxiety, or any new symptom from the injury. The provider believes that a timely assessment and referral is warranted. A Google Chat is sent to the other team members for collaboration, recommendations, and referrals rather than waiting several days to address the issue. See Google Chat Workspace Learning Center: https://support.google.com/a/users/answer/9300511?hl=en A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 45 Appendix G Red-Flagged & New Patients for Weekly Collaboration Patient ID Issue Plan A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 46 Appendix H Conduct Handout Adapted from (Deutsch, 1994), (Merrritt & Kelley, 2018), (Somech, 2009). Collaboration Meeting Conduct Hand-out Use language that- • Is courteous • Promotes respect • Establishes trust • Encourages thought • Builds relationships Use behavior that- • Demonstrates professionalism • Avoids judgement • Creates an environment of safety A COLLABORATIVE APPROACH TO TREAT ACUTE PAIN 47 Appendix I Timeline A Collaborative Approach to Treating Acute Pain SIMPLE GANTT CHART by Vertex42.com https://www.vertex42.com/ExcelTemplates/simple-gantt-chart.html Weber State University Project Lead: Suzy H Project Start: Display Week: 1 Oct 18, 2021 Oct 25, 2021 25 26 27 28 29 30 31 Nov 1, 2021 1 2 3 4 5 6 7 Nov 8, 2021 8 9 10 11 12 13 14 Nov 15, 2021 15 16 17 18 19 20 21 Nov 22, 2021 22 23 24 25 26 27 28 Nov 29, 2021 29 30 1 2 3 4 5 Dec 6, 2021 6 7 8 9 10 11 12 18 19 20 21 22 23 24 TASK ASSIGNED TO PROGRESS START END M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S Phase 1 Preparation & Design Task 1 IRB APProval Suzy 100% 10/19/21 10/22/21 Task 2 CITI Training 100% 10/22/21 10/24/21 Task 3 Information Tedhnology/Applying informatics 100% 10/24/21 10/28/21 Task 4 Deliverables Parts I, II, III 75% 10/28/21 8/2/21 Task 5 Affiliation Agreement 100% 10/23/21 10/25/21 Phase 2 Implementation Task 1 Project meeting to discuss Implementation 50% 7/9/21 7/13/21 Task 2 Weekly collaboration meetings 0% 10/1/21 2/20/22 Task 3 Implementation of CSACD 0% 10/1/21 1/29/22 Task 4 Chart Audits 4, 8, 12 0% 10/1/21 1/29/22 Task 5 Compilation of completed data 0% 10/1/21 1/29/22 Phase 3 Evaluation 7900-3: Project evaluation completed Task 1 TBD 0% 11/3/21 3/23/22 Task 2 0% 7/12/21 12/9/21 Task 3 0% 7/17/21 12/14/21 Task 4 0% 7/17/21 12/14/21 Task 5 0% 7/17/21 12/14/21 Phase 4 Dissemination 7803-Project completion and dissemination Task 1 TBD 0% date date Task 2 0% date date Task 3 0% date date Task 4 0% date date Task 5 0% date date Insert new rows ABOVE this one Tue, 10/19/2021