Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

患有癌症退伍军人的远程医疗研究和创新 (THRIVE)

基本信息

批准号：
10454675
负责人：
DANIL V. MAKAROV
金额：
$ 112.86万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-15 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10454675
关键词：
Academy Address Affect Breast Cancer Control Caring Cause of Death Colon Communication Consolidated Framework for Implementation Research Continuity of Patient Care Data Disadvantaged Discrimination Early Diagnosis Economics Ethnic Origin Funding Health Health Disparities Research Health Services Accessibility Health system Healthcare Healthcare Systems Improve Access Integrated Health Care Systems Laboratories Lung Malignant Neoplasms Medical center Medicine Methods National Institute on Minority Health and Health Disparities Oncology Outcome Outpatients Patient Care Patients Pattern Perception Persons Plant Roots Population Poverty Prostate Provider Quality of Care Race Research Research Methodology Research Personnel Site Social status System Testing Training Trust Veterans Veterans Health Administration adverse outcome base cancer care care delivery clinical practice digital disparity reduction experience health care delivery health care disparity health disparity health equity health inequalities implementation science implementation strategy improved innovation learning network next generation oncology program pandemic coronavirus pragmatic trial racial disparity recruit rurality screening social social determinants social health determinants survivorship telehealth telehealthcare uptake virtual virtual health virtual healthcare willingness

项目摘要

The rapid uptake of telehealth since the coronavirus pandemic has highlighted not only the potential for telehealth to improve access and quality of care for some but also how telehealth can exacerbate the “digital divide,” increasing disparities in care and highlighting the need to focus on health equity. Social, economic, environmental, and structural factors collectively known as social determinants of health (SDH) – account for 30-50% of the variance in health outcomes, far more than the 10-20% ascribed to health care. In order to achieve health equity, it is crucial to target these SDH. We will particularly focus on race/ethnicity, poverty and rurality and how they affect use of telehealth, which we refer to as social determinants of telehealth (SDTH). The Veterans Health Administration (VA) is the largest integrated health care system in the US, providing care to 9 million patients across 171 medical centers and 1,112 outpatient sites. VA provides a unique opportunity to examine how SDTH affect use of telehealth for cancer across a health care system with equal access and without focus on reimbursement. Therefore, the entire VA system will serve as our clinical practice network for this Center. All three THRIVE PI’s are experts in implementation science and will use the NIMHD Health Disparities Research Framework and the Consolidated Framework for Implementation Research to guide our understanding of telehealth care delivery for patients with cancer and to explore and understand disparities. We propose a Center called Telehealth Research and Innovation for Veterans with Cancer (THRIVE), whose overarching aim is two-fold: 1) to understand how SDTH impact the delivery of telehealth for cancer and 2) to develop methods to address SDTH and thereby improve access and quality of cancer care for all patients. THRIVE will focus on four highly important and prevalent cancers within VA: lung, colon, prostate, and breast. Our findings will be extremely valuable in understanding how telehealth implementation affects the quality of cancer care for the entire population and how VA and other US health systems can leverage telehealth to improve cancer outcomes and health equity. Our Specific Aims for this Center are: (1) efficiently manage all components of THRIVE, including coordination, communication, fiscal management, recruitment and dissemination (Administrative Core); (2) Identify the impact of SDTH on disparities in telehealth use for cancer care and on overall quality of care and to develop and test implementation strategies to mitigate disparities (Research and Methods Core); (3) Create a high functioning learning network to facilitate research on telehealth for cancer (Clinical Practice Network); (4) conduct a trial assessing the impact of a comprehensive, multilevel virtual oncology program on promoting engagement with telehealth and reducing SDTH-related care disparities (Pragmatic Trial); and (5) Train the next generation of oncology researchers in virtual care and health equity.

自冠状病毒大流行以来，远程医疗的迅速普及不仅凸显了远程医疗的潜力远程医疗可以改善某些人的护理机会和质量，但远程医疗会如何恶化“数字化” 鸿沟”，增加了护理方面的差距，并强调需要关注健康公平、社会、经济、环境和结构因素统称为健康的社会决定因素 (SDH) – 考虑 30-50% 的健康结果差异远高于 10-20% 归因于医疗保健的差异。为了实现健康公平，针对这些 SDH 至关重要，我们将特别关注种族/民族、贫困和问题。农村地区及其如何影响远程医疗的使用，我们将其称为远程医疗的社会决定因素（SDTH）。退伍军人健康管理局 (VA) 是美国最大的综合医疗保健系统，提供护理服务为 171 个医疗中心和 1,112 个 VA 门诊点的 900 万名患者提供了独特的机会。研究 SDTH 如何影响在具有平等机会和机会的医疗保健系统中使用远程医疗治疗癌症因此，整个 VA 系统将作为我们的临床实践网络。该中心的所有三位 THRIVE PI 都是实施科学方面的专家，并将使用 NIMHD Health。差异研究框架和实施研究综合框架指导我们了解为癌症患者提供远程医疗服务并探索和了解差异。我们提议建立一个名为癌症退伍军人远程医疗研究和创新 (THRIVE) 的中心，该中心总体目标有两个：1) 了解 SDTH 如何影响癌症远程医疗的提供；2) 开发解决 SDTH 的方法，从而改善所有患者的癌症护理机会和质量。 THRIVE 将重点关注 VA 内四种非常重要且普遍的癌症：肺癌、结肠癌、前列腺癌和乳腺癌。我们的研究结果对于了解远程医疗实施如何影响医疗质量非常有价值为全体人民提供癌症护理，以及 VA 和其他美国卫生系统如何利用远程医疗来改善癌症结果和健康公平。我们该中心的具体目标是：(1) 有效管理所有方面。 THRIVE 的组成部分，包括协调、沟通、财务管理、招聘和传播（管理核心）；(2) 确定 SDTH 对癌症远程医疗使用差异的影响护理和整体护理质量，并制定和测试实施战略以缩小差距（研究和方法核心）；（3）创建一个高功能的学习网络以促进研究癌症远程医疗（临床实践网络）；（4）进行一项试验，评估综合性、促进远程医疗参与和减少 SDTH 相关护理的多层次虚拟肿瘤学计划 (5) 培训下一代肿瘤学研究人员进行虚拟护理和健康公平