BraveNet Collaborative

Led by Jeff Dusek, PhD; Donald Abrams, MD; and Diane McKee, MD, MS, PRIMIER is a large prospective observational cohort study and currently BraveNet’s major focus. Centers participating in PRIMIER are uniformly collecting patient-reported outcomes and health record data into a large dataset. The PRIMIER registry utilizes the Patient-Reported Outcomes Measurement System (PROMIS) developed by the National Institutes of Health (NIH), which collects key patient-reported health symptoms and health-related quality of life, including pain, depression, fatigue, and physical function. These data, grouped by health condition, are matched with data collected in patients’ medical records. PRIMIER outcome data also includes measures of stress (PSS-4), patient activation (Patient Activation Measure), and lifestyle choices.

By clustering participants at the multiple clinical sites with the same medical condition, researchers are working to compare the impact of various integrative therapies on patient-reported and clinical outcomes. PRIMIER also provides much-needed clinical information on which real-world approaches to common clinical problems appear most effective, and which appear ineffective. The goal of PRIMIER is to help build the framework for discovering the “best practices” of integrative medicine.

“PRIMIER: A National Integrative Medicine Database” explains the PRIMIER project and offers a glimpse at preliminary results. The detailed protocol for PRIMIER was published in 2016 and can be found here.

Published in Complementary Therapeutic Medicine:

Dusek JA, Gao Q, Kim RS, Abrams DI, Kligler B, Dyer NL, Hansen K, McKee MD; PRIMIER Research Group. Patients Receiving Integrative Medicine Effectiveness Registry (PRIMIER) of the BraveNet practice-based research network: Outcomes of the PRIMIER cohort. Complement Ther Med. 2022 Nov 23;71:102904. doi: 10.1016/j.ctim.2022.102904. Epub ahead of print. PMID: 36435299.

DOI: 10.1016/j.ctim.2022.102904

Led by Carole Greco, PhD, at the University of Pittsburgh and involving the BraveNet sites at Venice Health Center and Allina Health System, this Patient-Centered Outcomes Research Institute (PCORI)-funded project is focused on the development of a new survey tool (HEAL) to measure the outcomes of the healing encounter. The investigators are evaluating factors that may predict which patients judge themselves to be improved, the same, or worsened. Some of the possible factors that may contribute to improvement include HEAL scores, emotional distress, or the preference for complementary and alternative medicine or conventional treatment.

Background: Questions such as who improves with treatment, which treatments are most appropriate for whom, and do patients’ perceptions influence outcomes, are highly relevant to patients and clinicians in making healthcare decisions. However, in most research studies, such questions are not addressed. This project focuses on these questions and will contribute to the understanding of treatment outcome differences based upon patients’ views of themselves and their treatment.

Methods: We will administer Healing Encounters and Attitudes Lists (HEAL) and other Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CATs) to 200 patients who are starting treatment for chronic pain in integrative medicine and conventional medicine settings. Follow-up assessments will be completed two and four months after baseline testing.

Objectives:

We aim to:

1. Evaluate whether the HEAL CATs predict chronic pain treatment outcomes
2. Examine heterogeneity of treatment effects based on HEAL and PROMIS scores in integrative and conventional medicine settings
3. Interview patients and their clinicians regarding the utility of HEAL, PROMIS, and a pain log for enhancing communication.

Patient Outcomes: We will evaluate factors that may predict which patients judge themselves to be improved, the same, or worsened. Some of the possible factors that may contribute to improvement include HEAL scores, emotional distress at baseline, or the preference for complementary and alternative medicine or conventional treatment. We are also interested in learning whether patients find the assessments to be clear and useful. A subset of 50 patients and approximately 10 clinicians will complete interviews about HEAL and PROMIS questions, and about the pain log developed by our patient advocacy group partner, the American Chronic Pain Association.