Onco-primary care networking to support TEAM-based care - the ONE TEAM Study

支持基于 TEAM 的护理的肿瘤初级护理网络 - ONE TEAM 研究

基本信息

批准号：
10524174
负责人：
Kevin Charles Oeffinger
金额：
$ 21.01万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-06 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10524174
关键词：
Acute Adherence Adult Affect Aftercare Aging Attention Back Behavior Behavioral Sciences Biometry Breast Cancer Center Cancer Patient Cancer Survivor Cardiovascular Diseases Caring Chronic Clinic Clinical Colorectal Communication Communities Data Education Effectiveness Electronic Health Record Emergency department visit Endometrial Enrollment Fibrinogen Genetic Goals Growth Head and neck structure Health Healthcare Healthcare Systems Hypertension Individual Institute of Medicine (U.S.)Institutes Interdisciplinary Study Internal Medicine Intervention Interview Laboratories Lead Length of Stay Letters Life Style Malignant Neoplasms Measurement Measures Mediating Medical Medical Oncologist Methods Newly Diagnosed Non-Insulin-Dependent Diabetes Mellitus Non-Small-Cell Lung Carcinoma North Carolina Oncologist Oncology Outcome Outpatients Participant Patient Care Patient-Focused Outcomes Patients Pharmaceutical Preparations Pharmacy facility Phase Population Population Heterogeneity Population Sciences Primary Health Care Productivity Prostate Provider Randomized Randomized Controlled Trials Reporting Research Research Design Risk Seminal Sequential Multiple Assignment Randomized Trial Series Specialist Survival Rate Survivors Therapeutic Time Touch sensation Training Visit base cancer care cancer recurrence cancer risk cancer therapy cardiovascular disorder risk care coordination care costs care delivery care providers comorbidity comparison intervention cost diet and exercise effectiveness evaluation empowered experience financial toxicity follow-up group intervention health care delivery hypercholesterolemia improved medication compliance member mortality risk patient oriented patient-clinician communication prevent primary outcome risk stratification sociodemographics survivorship theories treatment as usual trial design webinar

项目摘要

PROJECT SUMMARY Since the Institute of Medicine (IOM) released the seminal report, From Cancer Patient to Cancer Survivor: Lost in Transition 13 years ago, there has been substantial progress in understanding the health issues affecting cancer survivors, yet little has changed regarding survivorship care delivery. There remains a disconnect between primary care providers and oncology care teams that has led to persistent problems implementing risk-stratified survivorship care for cancer survivors. With advances in cancer therapy and improved survival rates, the risk of death from cardiovascular disease (CVD) now exceeds that of the cancer for many survivors. While cancer therapy may contribute to this risk, it is generally a compilation of non-modifiable factors (i.e., genetics, aging), as well as modifiable lifestyle behaviors (i.e., diet, exercise) that lead to both the cancer and to cardiovascular disease (CVD). With the lack of primary care provider (PCP) integration in the cancer care team and time constraints and difficulty keeping up with rapidly evolving non-cancer therapeutics for medical oncologists, there is an inferred lower priority for comorbidity management. We will determine the effectiveness of the multi-level iGuide intervention and the up-titrated iGuide2 intervention compared with usual care on the primary outcomes. The theory-driven, self-guided iGuide intervention consists of patient-level components (video vignettes, patient-facing webinars) and PCP-level components (electronic health record [EHR] automated cancer specialist-PCP letter, tele-education series, and automated reminders). The up-titrated iGuide2 intervention consists of tailored patient-level video vignettes and targeted EHR specialist-PCP communication. The primary outcomes of the ONE TEAM SMART-design study are (1) Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of the three CVD comorbidities (hypertension, type 2 diabetes mellitus, hypercholesterolemia) based upon laboratory and clinical measurement; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care). Secondary aims include exploring moderating and mediating factors in each level of the intervention, support of patient-centered outcomes, health care use, measures of provider activation, and costs of care resulting from the multi-level intervention. The overarching goal of this proposed project is to optimize the management and outcomes of individuals with cancer, both during and after treatment, and to develop a ‘low-touch’ multi-level intervention that can be generalized, adapted and scaled in other health care systems. The proposed ONE TEAM study brings together a multi-disciplinary research team with the necessary expertise and experience in survivorship research, population and behavioral science, primary care, oncology, and biostatistics. Results from this intervention will have important implications in the advancement of healthcare delivery for cancer survivors.

项目概要自从医学研究所 (IOM) 发布开创性报告《从癌症患者到癌症幸存者》以来： 13年前迷失在转型中，对健康问题的理解取得了实质性进展癌症幸存者，但幸存者护理服务方面几乎没有变化。初级保健提供者和肿瘤护理团队之间的脱节导致了持续存在的问题对癌症幸存者实施风险分层的生存护理。随着癌症治疗的进步和生存率的提高，心血管疾病死亡的风险降低对于许多幸存者来说，心血管疾病（CVD）现在超过了癌症，虽然癌症治疗可能会增加这种风险，但事实并非如此。通常是不可改变的因素（即遗传、衰老）以及可改变的生活方式行为的集合（即饮食、运动）会导致癌症和心血管疾病 (CVD)。护理提供者 (PCP) 融入癌症护理团队以及时间限制和难以跟上对于医学肿瘤学家来说，非癌症疗法快速发展，因此推断优先级较低合并症管理。我们将确定多级 iGuide 干预和升级 iGuide2 的有效性干预与常规护理对主要结果的比较。干预包括患者层面的部分（视频片段、面向患者的网络研讨会）和 PCP 层面组件（电子健康记录 [EHR] 自动癌症专家 PCP 信件、远程教育系列以及自动提醒）。升级的 iGuide2 干预由定制的患者级视频片段组成。以及有针对性的 EHR 专家与 PCP 沟通。 ONE TEAM SMART 设计研究的主要成果是 (1) 医疗保健有效性数据和三种 CVD 合并症（高血压、类型 2 糖尿病、高胆固醇血症）基于实验室和临床测量（2）药物治疗；使用覆盖天数比例 (PDC) 评估依从性的药房补充数据；以及 (3) 患者-提供者沟通（癌症护理中以患者为中心的沟通）包括探索。每个干预水平的调节和中介因素，支持以患者为中心的结果，医疗保健的使用、提供者激活的措施以及多层次干预产生的护理成本。该拟议项目的总体目标是优化个人的管理和结果癌症治疗期间和治疗后，并开发一种“低接触”的多层次干预措施拟议的 ONE TEAM 研究汇集了其他医疗保健系统中的普遍性、适应性和规模化。一个多学科研究团队，在生存研究方面具有必要的专业知识和经验，人口与行为科学、初级保健、肿瘤学和生物统计学将获得该干预的结果。对改善癌症幸存者的医疗保健服务具有重要影响。