Based on the document attached create the recommended modifications on the "final document"

In nurse practitioners and physicians treating adult patients with lumbar radiculopathy at a pain clinic (P), will implementation of an evidence-based Clinical Decision Support algorithm with provider education (I), compared with current prescribing practices (C), improve adherence to evidence-based prescribing guidelines by reducing opioid prescriptions, increasing appropriate antineuropathic medication prescribing, enhancing patient education, increasing referrals and adherence to physical therapy, and improving patient functional outcomes measured by the Oswestry Disability Index (ODI) (O) over an eight-week period (T)?

Population (P): Nurse practitioners and physicians treating adult patients with lumbar radiculopathy.

Intervention (I): Implementation of an evidence-based Clinical Decision Support algorithm combined with provider education.

Comparison (C): Current prescribing practices.

Outcomes (O): These are the measures we could collect before and during project implementation:

· Reduced opioid prescribing: Number of opioid prescriptions before and during implementation.

· Increased evidence-based antineuropathic medication prescribing: Number of appropriate antineuropathic medication prescriptions before and during implementation.

· Improved provider adherence to prescribing guidelines: We can discuss the best way to measure this. One option would be the number of patient encounters documenting that evidence-based alternatives were considered or initiated before prescribing opioids.

· Enhanced patient education: Number of documented patient education sessions before and during implementation.

· Increased referrals and adherence to physical therapy: Number of referrals to physical therapy and patient adherence rates before and during implementation.

· Improved patient functional outcomes: Comparison of Oswestry Disability Index (ODI) scores before and after implementation.

Time (T): Eight weeks.

Reviewer	Title	Comment
Dr. Melissa Lyapustina	6.5 Design and methods	Please clarify the statement "No PowerPoint presentation will be used if that is Valeria's actual plan," as a PowerPoint was uploaded. Thank you.
Dr. Melissa Lyapustina	6.5 Design and methods	As a reminder, please clarify here which algorithm is being used, such as the VA/DoD Clinical Practice Guideline for the Diagnosis which is what is stated in the educational materials. Thank you.
Dr. Melissa Lyapustina	6.7.a Data collection material	Please ensure that "Valeria survey.docx" has a title that matches the title on the recruitment script, "Implementation of an evidence-based anti-neuropathic prescribing protocol with a structured provider education program for nurse practitioners and physicians in a pain management clinic." The words "and physicians" are missing from the survey title. Thank you.
Dr. Melissa Lyapustina	6.7.a Data collection material	Please upload a copy of the Oswestry Disability Index. Thank you.
Dr. Melissa Lyapustina	11.5 Security precautions	As a reminder, please clarify where the DocuSign forms will be stored (stored on the secured laptop or stored physically.) Thank you.