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?The Pain Mobile?: Remote Pain Management System

Objective
Provide in-home access to coordinated comprehensive pain treatment through a mobile treatment platform.  This platform may range from a fully equipped mobile clinic, to a mobile extension of a traditional pain clinic, or a virtual network of mobile treatment services.  Note that opioids may be part of this comprehensive treatment plan and may be prescribed, if warranted, but will not be delivered through the pain mobile platform.
Background
Pain is a major health crisis in America, where chronic pain afflicts nearly a third of our population.  Opioids can be a powerful tool in fighting pain; however they are too often used as substitute for a comprehensive interprofessional pain treatment program.  Patients are merely sent home with a bottle of pills.  The result is pain is often inadequately treated and opioids are over used.   
In an effort to improve pain treatment and reduce dependence on opioids, NIDA is soliciting applications to create a mobile pain management system.   Core to this solicitation is the delivery of a comprehensive pain treatment system to a pain patient?s home, as it is difficult for many pain patients to make numerous needed visits to clinical settings. Opioids may be prescribed as part of this comprehensive treatment plan, but will not be dispensed.  The patients will have to get opioids from pharmacies (either in person or via a delivery system). 
This ?pain mobile? can be an actual portable clinic that is equipped and staffed to treat pain. Alternatively, it can be more of a virtual remote pain treatment system, where health care providers get to patients homes using various means other than a devoted vehicle. It can also be a hybrid of these approaches.  However, it is crucial that visits and treatments are coordinated in a way that delivers comprehensive and appropriate pain treatment.  This coordination can be done from the actual pain mobile or via a remote site.
The health care providers that visit the pain patients need to have appropriate training (e.g. nurse practitioner); but they do not have to be clinicians.   However, it is essential that clinicians are involved in many aspects of the patients care, including assessment, diagnosis, and management, planning, and prescribing of drugs.  This clinician input can take many forms, and can include occasional office visits by the patients and having the clinician remotely see the patients using various telemedicine technologies (e.g., Skype).
In many cases, as part of a complete pain treatment program, we expect that various other health care providers would visit the pain patients in a coordinated fashion.  These may include acupuncturists, physical therapists, massage therapists, cognitive/behavioral psychologists and others depending on patient needs.   Again, these visits need to be coordinated, and progress needs to be monitored.  Further, this treatment systems needs to be flexible and change with the needs of the patients.  
Given that the ?pain mobile? approach involves going to the patients? homes, it offers some unique opportunities not available with visits to clinics.  With home visits, it is possible to assess the home environment and also to educate patient and those living with the patient. As part of the ?pain mobile? program, we expect that at least one of the health care providers that go to the patient?s residence be trained to evaluate the living conditions of the patient and when appropriate, suggest improvements that will allow the patient to function better in their home environment despite their condition.   If the patient is using opioid pain medications, how these drugs are stored and secured will be examined.   The health care provider will also be expected to educate the pain patient and co-inhabitants of the home about the safe use of opioids. 
While this is a small scale project, we would like the chosen model to be economically viable and potentially expanded.   To make this more likely, the offeror must describe a plan of how they will make this project not only self-sustaining, but also expandable.  Agreements with existing health care providers, health insurance companies, health services providers or the like is required.   If the pilot project funded under this contract is shown to be economically viable on a small scale, we envision that this will encourage provider partners to expand this system within their existing networks, and thus expand the impact of this effort.
Phase I Activities and Expected Deliverables:
Technical Requirements
1.      Assemble a team of professionals to work together to provide comprehensive pain treatment.
2.      Develop a plan to deliver coordinated comprehensive pain treatment, including determined the frequency of home visits, the need for in clinic consultations and testing, the coordination plan of treatment delivery (who goes where and when), the development of hardware and software needed in the coordination of care and store/access data, and a plan to insure data security.
3.      Built/equip the pain mobile itself with all the needed medical and communication requirements.
4.      Develop a plan for compensation of services that does not sole or largely rely on the patient paying for services out of pocket.  This may take many forms but could include a contractual relationship with a heath care insurer.
5.      Recruit a patient population.
6.      Perform pilot testing of the system and services for feasibility.
 
Phase II Activities and Expected Deliverables:
Technical Requirements
1.      Provide pain treatment from the pain mobile full-time on a cohort of chronic pain patients.
2.      Test for efficacy of the pain mobile.  This could include surveys of patient satisfaction as well as impact of treatment on the patient?s pain and quality of life.  These measures could include measures of pain, depression, mood, function, level of use of opioids, activity levels and other indicators of successful pain treatment.  These data could be compared across time within this cohort of pain patients, and/or related to a comparison group of pain patients treated in a traditional clinical setting.
3.      Results from the above testing should be disseminated via conference presentations and manuscript publications.
 

Centers for Disease Control and Prevention (CDC)

Center for Global Health (CGH)
The Center for Global Health (CGH) leads the execution of the CDC?s global strategy; works in partnership to assist Ministries of Health to plan, manage effectively, and evaluate health programs; achieves U.S. Government program and international organization goals to improve health, including disease eradication and elimination targets; expands CDC?s global health programs that focus on the leading causes of mortality, morbidity and disability, especially chronic disease and injuries; generates and applies new knowledge to achieve health goals; and strengthens health systems and their impact.
CGH Internet site:  https://www.cdc.gov/globalhealth/
 
For this solicitation CGH invites Phase I proposals in the following area:

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