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.

项目概要 该提案的总体目的是对远程围手术期进行试点随机试验 远程监控干预改善以患者为中心的结果、手术结果和医疗资源 用于计划患有主要腹部胃肠癌的英语和西班牙语患者 这项研究至关重要，因为癌症手术后，患者的病情会突然下降。 大多数人的功能能力、症状增加和生活质量总体急剧下降 术后护理和康复在家中进行，身体机能可能会在手术前下降。 手术团队收到通知导致三分之一的患者出现并发症症状， 可能需要重新入院监测围手术期的症状，包括生命体征、体重、 采取的步骤和患者报告的结果提供了在围手术期进行干预的机会 干预措施是围手术期测量，以减轻并发症和再入院的严重程度。 两组参数均采用护理分类作为干预措施，以拦截并发症并改善 我们将使用 1:1 随机化对干预措施进行试点测试，以实现以下目标。 具体目标：具体目标 1：评估远程围手术期的可行性、保留性和可接受性 远程监控干预以 a) 同意参与 b) 完成的患者百分比来衡量； >70% 的远程监控；和 c) 通过结构化退出访谈报告对干预的满意度； 具体目标 2：确定远程围手术期远程监护干预对患者的初步效果 该提案具有创新性，因为它涉及手术结果、医疗保健利用、PRO 和功能恢复。 我们是最早也是少数研究将以患者为中心的结果转化为可操作的方法的人之一 除了使用现有的数字技术之外，还使用客观和主观措施进行术后癌症护理 健康基础设施（AetonixTM）利用“现实世界”平台扩展到外科肿瘤学。 跨学科团队包括肿瘤外科 (Melstrom) 和护理科学 (Sun) 方面的专业知识 该研究非常适合开展这项研究，意义重大，具有较高的科学研究和成果。 这对于癌症患者、信徒、医疗保健系统和社会的围手术期护理至关重要 国家癌症研究所。这项研究将解决围手术期知识方面的一个关键差距。 客观和主观数据的远程监测将改善围手术期癌症的结果和转变 我们的长期目标是进行多地点的 III 期试验。 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.