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.

项目概要/摘要 胸外科手术后的严重并发症很常见，导致再入院率和死亡率增加 死亡。通常的计划可能无法检测到出现并发症的早期症状 在病情恶化和变得严重之前进行术后护理。术后护理可以远程进行 实时通过自动化系统以电子方式向患者提供调查，以直接捕获患者的信息 报告结果并向提供商发送有关响应的警报 (ePRO)。 ePRO 提高质量 几项大型临床试验中对生命、医疗保健利用和生存的影响，并且有新的证据表明 在肿瘤患者的实际应用中的临床有效性。 ePRO 还被证明是 对于胸外科和结直肠手术患者的小规模试验中的症状管理是可行的。这些数据 表明 ePRO 有可能改善胸部手术和其他高风险手术后的护理。然而，有 尽管其他环境有证据表明 ePRO 系统尚未在常规外科护理中广泛实施 支持系统地识别并解决预期实施障碍的价值 ePRO 设计。目前在设计用于外科护理的 ePRO 方面的知识差距包括识别 最佳调查/警报功能和工作流程、常规使用的障碍以及临床有效性。 本次职业发展奖的候选人莫迪博士是一位胸外科医生，他的职业目标 旨在改善慢性肺病患者的临床和以患者为中心的结果 外科手术。拟议的奖项将建立在她之前的公共卫生硕士学位的基础上，其中包括生物统计学和 卫生服务研究并将在她实现职业生涯所需的领域提供高级培训 目标。具体来说，在颁奖期间，Mody 博士将接受定性数据分析方面的培训，包括 混合方法和实施科学研究方法。莫迪博士将进行一项前瞻性研究 胸外科诊所使用术后 ePRO 的实施和效果结果。为确保 她的成功得益于一支由具有互补专业知识的导师和顾问组成的跨学科团队 入伍的包括 Ethan Basch 博士（肿瘤学临床试验、PRO 研究）、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（外科临床试验、PRO 研究）、Angela Smith 博士（外科、健康信息） PRO 测量技术）和 Angela Stover 博士（PRO 的实施）。到年底 颁奖期间，么迪博士将拥有必要的初步数据和培训，以成功地进行大型 规模随机对照试验，以评估 ePRO 系统的实施和有效性 心胸外科患者。首先在胸外科患者中设计和评估这样的系统是 重要的是，它们为越来越多的复杂医学患者提供了模型 针对慢性病的侵入性治疗以及 ePRO 可以显着改善治疗效果。