SymptomCare@Home (SCH): Deconstructing an effective, technology-assisted, symptom management intervention

SymptomCare@Home (SCH)：解构有效的、技术辅助的症状管理干预措施

• 批准号: 9903257
• 负责人: KATHLEEN H MOONEY
• 金额: $ 85.88万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903257
• 关键词: Absenteeism; Accelerometer; Accident and Emergency department; Address; Adherence; Adopted; Adoption; Affect; Cancer Etiology; Cancer Patient; Caring; Characteristics; Chemotherapy-Oncologic Procedure; Clinic Visits; Clinical; Control Groups; Decision Support Systems; Distress; Exercise; Fatigue; Health; Healthcare Systems; Home environment; Individual; Infusion procedures; Intervention; Monitor; Nurse Practitioners; Oncology; Outpatients; Participant; Patient Outcomes Assessments; Patients; Physical activity; Process; Productivity; Provider; Psyche structure; Public Health; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Reporting; Research; Self Management; Severities; Symptoms; System; Technology; Telephone; Testing; Time; Translating; Work; base; cancer care; cancer therapy; care systems; chemotherapy; clinical implementation; clinical practice; control trial; cost; cost effective; cost effectiveness; disabling symptom; eHealth; economic evaluation; evidence based guidelines; experience; follow-up; health care service utilization; hospital services; innovation; multi-component intervention; novel strategies; physical symptom; psychological symptom; public health relevance; reduce symptoms; response; satisfaction; side effect; social; symptom management; telehealth; telehealth systems; treatment arm; treatment as usual; trial design; urgent care; usability; willingness to pay

 DESCRIPTION (provided by applicant): Cancer patients receiving chemotherapy experience multiple poorly controlled symptoms at home in the interim weeks between clinic visits and the next infusion. Their care during this interim time period is suboptimal. Technology can be utilized to bridge the gap between patient symptom needs at home and oncology team response. Automated patient-reported symptom home monitoring and management systems offer a new approach to symptom care. Our research team has developed and tested SymptomCare@Home (SCH). This multi-component automated system monitors daily patient-reported symptoms at home, provides tailored automated self-management coaching based on the specific symptoms reported and transmits unrelieved symptom alert reports to an oncology provider who, using the SCH decision support system provides follow-up telephone-delivered symptom care. We have demonstrated that SCH dramatically reduces physical and psychological symptom severity. However there remain several gaps in translating a successful, multi-component symptom intervention into clinical practice. These include understanding 1) the contribution and value of each part of the intervention so that the active components are selected for clinical implementation and 2) the costs associated with the intervention and its components. Therefore the aims of this project are to deconstruct the SCH symptom monitoring and management system to determine the relative contribution and costs of its components to achieving symptom reduction, maintain general health functioning and reduce healthcare utilization. We will also examine who benefits most and least from the individual components and from the overall system. A 5 group randomized control trial design will be utilized with 750 participants (150/group) beginning a new course of chemotherapy who will call the SCH system daily and report the presence and severity of 11 symptoms throughout a course of chemotherapy or up to 6 months. This study is both significant and innovative because it shifts the current clinical practice paradigm for providing symptom care episodically during clinic visits to an innovative approach that is patient-centric, providing symptom care when and where the patient needs it. The study will address questions not generally asked in multi-component interventions, determining the active ingredients and their costs. Determining the value of new approaches to care such as automated telehealth interventions is essential to the decision process of healthcare systems and payers who decide what to adopt and reimburse. It is also vitally important to patients so that new symptom care innovations are adopted that better meet their needs and dramatically reduce their symptoms.

 描述（由申请人提供）：接受化疗的癌症患者在就诊和下一次输注之间的中间几周内，在家中会出现多种控制不佳的症状。在此期间，他们的护理效果不佳，可以利用技术来弥补患者之间的差距。家庭症状需求和肿瘤团队响应 自动化患者报告的症状家庭监测和管理系统提供了一种新的症状护理方法。我们的研究团队开发并测试了 SymptomCare@Home (SCH)。在家中监控每日患者报告的症状，根据报告的具体症状提供量身定制的自动化自我管理指导，并将未缓解的症状警报报告传输给肿瘤科提供者，肿瘤科提供者使用 SCH 决策支持系统提供后续电话提供的症状护理。我们已经证明 SCH 可以显着降低身体和心理症状的严重程度，但是在将成功的多成分症状干预转化为临床实践方面仍然存在一些差距，其中包括理解 1) 干预的每个部分的贡献和价值。活性成分选择临床成本，2) 与干预措施及其组成部分相关，因此该项目的实施是解构 SCH 症状监测和管理系统，以确定其组成部分对实现症状减轻、维持总体状况的相对贡献和成本。我们还将检查谁从各个组成部分和整个系统中受益最多和最少，将采用 750 名参与者（每组 150 名）开始新的化疗过程。谁来呼叫 SCH 系统每天并报告整个化疗过程或长达 6 个月的 11 种症状的存在和严重程度。这项研究既重要又具有创新性，因为它改变了当前在门诊期间定期提供症状护理的临床实践范式。 以患者为中心的创新方法，在患者需要的时间和地点提供症状护理。该研究将解决多成分干预措施中通常不会提出的问题，确定活性成分及其成本。诸如自动化远程医疗干预之类的护理对于医疗保健系统和决定采用什么和报销的付款人的决策过程至关重要。这对于患者也至关重要，以便采用新的症状护理创新来更好地满足他们的需求并显着减轻他们的症状。 。