Pragmatic Trial - Telehealth Research and Innovation for Veterans with Cancer (THRIVE).

务实试验 - 癌症退伍军人远程医疗研究和创新 (THRIVE)。

基本信息

批准号：
10684282
负责人：
DANIL V. MAKAROV
金额：
$ 30.84万
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/10684282
关键词：
Accounting Administrator Affect Attitude Behavior Breast COVID-19 pandemic Cancer Center Caring Cessation of life Client satisfaction Clinical Services Colon Carcinoma Colorectal Colorectal Cancer Communication Continuity of Patient Care Diagnosis Disparity Equity Ethnic Origin Goals Health Disparities Research Health Personnel Health Services Accessibility Healthcare Systems Home Individual Integrated Health Care Systems Intervention Intervention Studies Interview Knowledge Label Leadership Malignant Neoplasms Malignant neoplasm of lung Malignant neoplasm of prostate Measures Medical Methods Mission Modeling National Institute on Minority Health and Health Disparities Oncology Outcome Participant Patient Care Patients Performance Play Populations at Risk Poverty Program Sustainability Prostate Provider Public Health Race Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Reporting Research Role Services Single-Payer System Structure Time United States Veterans Veterans Health Administration Visit Vulnerable Populations Woman cancer care cancer health disparity cancer subtypes cancer therapy care coordination cost cost outcomes digital effectiveness evaluation effectiveness testing effectiveness/implementation study effectiveness/implementation trial experience hands-on learning health care disparity health care service utilization health equity health equity promotion health management implementation outcomes improved innovation intervention cost malignant breast neoplasm men mortality oncology program population health pragmatic trial programs risk minimization rurality satisfaction screening service delivery social determinants social health determinants successful intervention telehealth teleoncology virtual virtual delivery

项目摘要

Four cancers – lung, colorectal, prostate and breast – account for nearly half of all cancer deaths among men and women in the United States. Social determinants of telehealth (SDTH), such as race/ethnicity, poverty and rurality, individually and in additive or synergistic combinations play an important role in access to and outcomes from cancer care, often accounting for the observed cancer care disparities. Veterans Health Administration (VA) is the largest integrated provider of cancer care in the US and provides state of the art cancer care to millions of veterans. Yet even within VA, routinely praised for its equal access to care model, disparities in cancer care persist. However, while VA serves a population at risk for SDTH driven healthcare disparities, it also leverages the advantages of an integrated national single-payer system, such as care coordination and telehealth, to improve health equity. Widespread use of telehelath in oncology creates both challenges and opportunities to expand access and improve care. In some cases, however, reliance on telehealth may widen the “digital divide” for those with limited ability to access it. A major knowledge gap exists regarding the optimal way to integrate telehealth into oncology practice across the care continuum. Our overarching aim is to improve the quality and equity of cancer care across the United States by leveraging lessons learned applying telehealth treating veterans with cancer in VA’s integrated health care system. The objective of the pragmatic trial to test the effectiveness of an existing, ongoing clinical service, the VA National TeleOncology program (NTO), a multilevel telehealth population health management program. We propose a stepped wedge, cluster randomized, hybrid effectiveness-implementation study of NTO among veterans diagnosed with prostate, lung, colon and breast cancers in VA. Using the NIMHD Health Disparities Research Framework, we will employ mixed methods to explore the association across SDTH between NTO and 1) service delivery outcomes, 2) hierarchical cancer outcomes, and 3) implementation outcomes. Specifically, the aims of the pragmatic trial are to: (1) Evaluate the effect of a comprehensive multilevel virtual oncology program to promote telehealth engagement on stakeholder (patient, provider, administrator) cancer care experience across SDTH; (2) Evaluate the effect of a comprehensive, multilevel virtual oncology program on quality of cancer care in veterans diagnosed with lung, colorectal, prostate and breast cancer across SDTH; and (3) Determine the impact and cost of a comprehensive multilevel teleoncology program. Our proposed hybrid effectiveness implementation trial to evaluate a comprehensive virtual oncology program to promote telehealth engagement and health equity has high potential for scalability and public health impact both within and outside of VA.

四种癌症——肺癌、结直肠癌、前列腺癌和乳腺癌——占男性癌症死亡人数的近一半以及美国远程医疗的社会决定因素 (SDTH)，例如种族/民族、贫困和农村，无论是单独的还是相加或协同的组合，在获取和利用农村地区方面发挥着重要作用。癌症护理的结果，通常解释了观察到的退伍军人健康差异。 Administration (VA) 是美国最大的癌症护理综合提供商，提供最先进的服务然而，即使在退伍军人管理局内部，其平等的医疗服务模式也经常受到赞扬，然而，尽管 VA 为面临 SDTH 驱动的医疗保健风险的人群提供服务，但癌症护理方面的差异依然存在。它还利用了综合国家单一支付系统的优势，例如护理协调和远程医疗，以改善卫生公平。远程医疗在肿瘤学中的广泛使用既带来了挑战，也带来了扩大可及性和机会然而，在某些情况下，对远程医疗的依赖可能会扩大患者的“数字鸿沟”。关于将远程医疗整合到其中的最佳方式，存在着重大的知识差距。我们的总体目标是提高整个护理过程中的肿瘤学实践的质量和公平性。通过利用远程医疗治疗退伍军人的经验教训，在美国各地开展癌症护理退伍军人管理局综合医疗保健系统中的癌症。务实试验的目的是测试现有的、正在进行的临床服务 VA 的有效性国家远程肿瘤学计划 (NTO)，一个多层次的远程医疗人群健康管理计划。提出了一种 NTO 的阶梯楔形、聚类随机、混合有效性实施研究使用 NIMHD 健康差异在 VA 诊断出患有前列腺癌、肺癌、结肠癌和乳腺癌的退伍军人。研究框架，我们将采用混合方法来探索 NTO 之间跨 SDTH 的关联 1) 服务提供结果，2) 分层癌症结果，以及 3) 实施结果。具体来说，务实试验的目的是：（1）评估综合多层次虚拟的效果促进利益相关者（患者、提供者、管理人员）癌症远程医疗参与的肿瘤学计划 (2) 评估综合、多层次虚拟肿瘤学项目的效果 SDTH 中被诊断患有肺癌、结直肠癌、前列腺癌和乳腺癌的退伍军人的癌症护理质量； (3) 确定综合性多层次远程肿瘤学计划的影响和成本。我们提出的混合有效性试验旨在评估综合虚拟肿瘤学计划的实施情况促进远程医疗参与和健康公平具有很大的可扩展性和公共卫生影响潜力 VA 境内和境外。