Perioperative Telemonitoring to Optimize Cancer Care and Outcomes

围手术期远程监测可优化癌症护理和结果

• 批准号: 10392999
• 负责人: LALEH MELSTROM
• 金额: $ 22万
• 依托单位: BECKMAN RESEARCH INSTITUTE/CITY OF HOPE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-14 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392999
• 关键词: Abdomen; Activities of Daily Living; Address; American College of Surgeons; Applications Grants; Blood Pressure; Cancer Patient; Caring; Cities; Clinical; Collaborations; Complication; Data; Data Analyses; Data Collection; Development; Discipline of Nursing; Distress; Early identification; Effectiveness; Environment; Fatigue; Feedback; Goals; Health; Healthcare; Healthcare Systems; Heart Rate; Home; Hospitalization; Hospitals; Infrastructure; Institute of Medicine (U.S.); Intercept; Intervention; Intervention Trial; Interview; Knowledge; Length of Stay; Malignant neoplasm of gastrointestinal tract; Measurement; Measures; Methods; Modeling; Monitor; National Cancer Institute; National Institute of Nursing Research; Nursing Assessment; Operative Surgical Procedures; Outcome; Pain; Patient Outcomes Assessments; Patient Schedules; Patient-Focused Outcomes; Patients; Perioperative; Perioperative Care; Physical Function; Physiologic Monitoring; Postoperative Care; Postoperative Complications; Postoperative Period; Procedures; Pulse Oximetry; Quality of life; Randomized; Recovery; Recovery of Function; Reporting; Research; Research Institute; Resources; Risk; Role; Sample Size; Science; Severities; Site; Strategic Planning; Structure; Surgical Oncology; Symptoms; System; Technology; Temperature; Testing; The Sun; Time; Triage; Weight; arm; cancer care; cancer surgery; cancer therapy; care outcomes; digital health; experience; functional decline; health care service utilization; health data; hospital readmission; implementation intervention; implementation strategy; improved; improved outcome; innovation; member; monitoring device; novel strategies; patient oriented; pedometer; phase III trial; pilot test; postoperative recovery; pressure; randomized trial; readmission rates; response; satisfaction; surgery outcome; symptomatic improvement; telehealth; telemonitoring; treatment as usual; trend; trial design

PROJECT SUMMARY The overall purpose of this proposal is to conduct a pilot randomized trial of a remote perioperative telemonitoring intervention to improve patient-centered outcomes, surgical outcomes and healthcare resource use in English and Spanish-speaking patients scheduled to undergo major abdominal gastrointestinal cancer surgery. This research is critical because after cancer surgery, patients experience abrupt declines in functional capacity, increase in symptoms and an overall dramatic decline in quality of life with the majority of postoperative care and recovery taking place at home. While at home, physical function can decline prior to the surgical team being notified leading up to one third of patients becoming symptomatic from a complication that may require readmission. Telemonitoring of symptoms in the perioperative period including vital signs, weight, steps taken and patient reported outcomes allows for an opportunity to intervene in the perioperative period to mitigate severity of complications and readmissions. The intervention is perioperative measurement of parameters in both groups with a nursing triage as the intervention to intercept complications and to improve patient reported outcomes. We will pilot test the intervention using a 1:1 randomization to pursue the following specific aims: Specific Aim 1: Assess the feasibility, retention, and acceptability of the remote perioperative telemonitoring intervention as measured by the percentage of patients who a) agree to participate; b) complete >70% of the telemonitoring; and c) report satisfaction with the intervention through structured exit interviews; Specific Aim 2: Determine the preliminary efficacy of the remote perioperative telemonitoring intervention on surgical outcomes, healthcare utilization, PROs, and functional recovery. This proposal is innovative because we are among the first and few to study methods of transforming patient-centered outcomes into actionable postoperative cancer care using objective and subjective measures in addition to using an existing digital health infrastructure (AetonixTM) leveraging a “real world” platform for expansion into surgical oncology. The interdisciplinary team which includes expertise in surgical oncology (Melstrom) and nursing science (Sun) is uniquely suited to conduct this research. The proposal is significant, with high scientific rigor and outcomes that are of critical importance in perioperative care to cancer patients, clinicians, healthcare systems and the National Cancer Institute. This research will address a critical gap in knowledge of how perioperative telemonitoring of objective and subjective data will improve outcomes and transitions of perioperative cancer care outside of the hospital setting. Our long-term objective is to conduct a multi-site, Phase III trial of the intervention to establish effectiveness.

项目摘要 该提案的总体目的是进行遥远时期的试点随机试验 远程监控干预措施以改善以患者为中心的结果，外科结果和医疗资源 用于英语和西班牙语的患者，计划发生重大腹部胃肠道癌 外科手术。这项研究至关重要，因为癌症手术后，患者突然下降 大多数 术后护理和康复在家进行。在家里，身体机能可能会下降 从外科团队通知手术团队，导致三分之一的患者因并发症而成为症状 可能需要再入院。定期期间症状的远程监控，包括生命体征，体重， 采取的步骤和患者报告的结果使得有机会在定期期间进行干预 减轻并发症和再入院的严重程度。干预是定期测量的 两组的参数都有护士分类作为拦截并发症并改善的干预措施 患者报告的结果。我们将使用1：1随机化测试干预措施以追求以下 具体目的：特定目的1：评估远程时期的可行性，保留和可接受性 通过a）同意参加的患者百分比来衡量的远程监控干预措施； b）完成 > 70％的远程监控器； c）通过结构化退出访谈报告对干预的满意； 特定目标2：确定远程周期性远程监控干预的初步效率 手术结果，医疗保健利用，专业人士和功能恢复。该建议具有创新性，因为 我们是研究以患者为中心的结果为可行的最早和少数人之一 术后癌症护理除了使用现有数字措施外，还采用客观和主观措施 卫生基础设施（Aetonixtm）利用“现实世界”平台扩展到手术肿瘤学。这 跨学科团队包括外科肿瘤学专业知识（Melstrom）和护士科学（Sun） 非常适合进行这项研究。该提案很重要，具有高度严格和结果 对于癌症患者，临床医生，医疗保健系统和 国家癌症研究所。这项研究将解决有关周期性如何的关键差距 客观和主观数据的远程监控将改善定期癌症的结果和过渡 在医院环境外关怀。我们的长期目标是进行多站点的第三阶段试验 干预以建立有效性。

项目成果

Randomized Controlled Trial of Perioperative Telemonitoring of Patient Generated Health Data in Gastrointestinal Oncologic Surgery: Assessing Overall Feasibility and Acceptability.

• DOI: 10.1007/s00268-023-07179-y
• 发表时间: 2023-12
• 期刊: WORLD JOURNAL OF SURGERY
• 影响因子: 2.6
• 作者: Limbach, Kristen;Esslin, Patricia;Sun, Virginia;Fan, Darrell;Kaiser, Andreas M.;Paz, I. Benjamin;Raoof, Mustafa;Lewis, Aaron;Melstrom, Kurt A.;Lai, Lily;Woo, Yanghee;Singh, Gagandeep;Fong, Yuman;Melstrom, Laleh G.
• 通讯作者: Melstrom, Laleh G.