Improving Thoracic Surgical Care using electronic Patient-Reported Outcomes (ePROs)

使用电子患者报告结果 (ePRO) 改善胸部外科护理

• 批准号: 10371437
• 负责人: Gita Natwar Mody
• 金额: $ 20.22万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10371437
• 关键词: Address; Adoption; Area; Award; Awareness; Biometry; COVID-19; Cancer Patient; Caring; Cessation of life; Chest; Chronic; Clinic; Clinic Visits; Clinical; Clinical Trials; Clinical effectiveness; Colorectal Surgery; Complex; Complication; Computer software; Consolidated Framework for Implementation Research; Coupled; Data; Data Analyses; Data Sources; Dyspnea; Early Diagnosis; Effectiveness; Emergency department visit; Enrollment; Ensure; Environment; Excision; Feedback; Frequencies; Future; Goals; Health Services Research; Home; Individual; International; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Lung; Lung diseases; Measurement; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; Monitor; National Heart, Lung, and Blood Institute; North Carolina; Nurse Practitioners; Oncology; Operative Surgical Procedures; Outcomes Research; Pain; Patient Monitoring System; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Population; Positioning Attribute; Postoperative Care; Postoperative Period; Prospective Studies; Protocols documentation; Provider; Pus; Qualitative Research; Quality of life; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Recovery; Repeat Surgery; Reporting; Research; Research Infrastructure; Research Methodology; Resources; Risk; Role; Schedule; Scientist; Structure; Surgeon; Surveys; Symptoms; System; Testing; Thoracic Surgeon; Thoracic Surgical Procedures; Time; Training; Universities; Use Effectiveness; Work; base; career; clinical center; design; effectiveness outcome; health care service utilization; health data; health information technology; high risk; hospital readmission; implementation barriers; implementation evaluation; implementation fidelity; implementation framework; implementation outcomes; implementation science; improved; improved outcome; mortality; novel; participant enrollment; practice factors; prevent; randomized trial; real world application; remote monitoring; respiratory; response; routine care; skills; success; surgery outcome; surgical risk; symptom management; virtual healthcare

Project Summary/Abstract Severe complications after thoracic surgery are common and lead to increased readmissions and mortality. The early symptoms of developing complications may not be detected by the usual scheduled postoperative care before they worsen and become severe. Postoperative care can be done remotely and in real-time with automated systems that electronically deliver surveys to patients to directly capture patient- reported outcomes and send alerts to providers for concerning responses (ePROs). ePROs improve quality of life, healthcare utilization, and survival in several large clinical trials as well as have emerging evidence of clinical effectiveness in real-world applications in oncology patients. ePROs also have been shown to be feasible for symptom management in small trials of thoracic and colorectal surgery patients. These data suggest ePROs have the potential to improve care after thoracic and other high-risk surgery. However, there are no widely implemented ePRO systems in routine surgical care, despite evidence from other settings to support the value of systematically identifying and then addressing anticipated barriers to implementation in the ePRO design. Current gaps in knowledge to designing ePROs for use in surgical care include identifying optimal survey/alert features and workflow, barriers to routine use, and clinical effectiveness. The candidate for this career development award, Dr. Mody, is a thoracic surgeon whose career goal is to improve clinical and patient-centered outcomes for patients with chronic lung conditions requiring surgery. The proposed award will build on her prior MPH that included formal training in biostatistics and health services research and will provide advanced training in areas necessary for her to achieve her career goals. Specifically, during the award period Dr. Mody will receive training in qualitative data analysis including mixed methods and implementation science research methods. Dr. Mody will perform a prospective study of implementation and effectiveness outcomes in thoracic surgery clinics using postoperative ePROs. To ensure her success, an interdisciplinary team of mentors and advisors with complementary expertise have been enlisted including Dr. Ethan Basch (clinical trials in oncology, PRO research), Dr. Jennifer Leeman (implementation, qualitative research), Dr. Antonia Bennett (quality of life measurement, qualitative research), Dr. Andrea Pusic (clinical trials in surgery, PRO research), Dr. Angela Smith (surgery, health information technology for PRO measurement), and Dr. Angela Stover (implementation of PROs). By the end of the award period, Dr. Mody will have the necessary preliminary data and training to successfully perform a large scale randomized controlled trial to evaluate the implementation and effectiveness of an ePRO system in cardiothoracic surgery patients. Designing and evaluating such a system in thoracic surgery patients first is important as they serve as a model for the increasing numbers of medically complex patients requiring invasive treatments for chronic conditions and for whom ePROs may substantially improve outcomes.

项目摘要/摘要 胸手术后的严重并发症很常见，并导致再入院增加和 死亡。通常的计划无法检测到发展并发症的早期症状 术后护理在他们恶化并变得严重之前。术后可以远程护理 使用自动化系统实时以电子方式向患者进行调查，以直接捕获患者 - 报告的结果并将警报发送给提供商以获取有关响应的有关（EPRO）。 EPRO提高质量 在几项大型临床试验中的生活，医疗保健利用和生存以及有新兴的证据 现实世界中肿瘤患者的临床有效性。 EPRO也已被证明是 在胸腔和结直肠手术患者的小型试验中，可用于症状管理。这些数据 建议EPRO在胸腔和其他高风险手术后有可能改善护理。但是，那里 尽管从其他环境到 支持系统识别的价值，然后解决预期的实施障碍 EPRO设计。当前知识上设计EPRO用于手术护理的差距包括识别 最佳调查/警报功能和工作流程，常规使用障碍以及临床有效性。 该职业发展奖的候选人Mody博士是一位胸外科医生，其职业目标 是为患有慢性肺部疾病的患者改善以患者为中心的临床和以患者为中心的结果 外科手术。拟议的奖项将以她先前的MPH为基础，其中包括生物统计学和 卫生服务研究将为她实现自己的职业所必需的领域提供高级培训 目标。具体而言，在奖励期间，莫迪博士将接受定性数据分析的培训 混合方法和实施科学研究方法。莫迪博士将对 使用术后EPROS在胸手术诊所的实施和有效性结果。确保 她的成功，是由互补专业知识的导师和顾问组成的跨学科团队 入伍包括Ethan Basch博士（肿瘤学的临床试验，Pro Research），Jennifer Leeman博士 （实施，定性研究），Antonia Bennett博士（生活质量测量，定性研究）， Andrea Pusic博士（手术临床试验，专业研究），Angela Smith博士（手术，健康信息 专业测量技术）和Angela Stover博士（专业人士的实施）。到结束 奖励期，莫迪博士将拥有必要的初步数据和培训，以成功执行大型 比例随机对照试验，以评估EPRO系统的实施和有效性 心胸外科手术患者。首先，在胸手术患者中设计和评估这种系统是 很重要，因为它们是越来越多的医学复杂患者的模型 针对慢性疾病的侵入性治疗以及EPRO可能会大大改善结果。