Research and Methods Core - Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

研究和方法核心 - 患有癌症的退伍军人的远程医疗研究和创新 (THRIVE)

• 批准号: 10684274
• 负责人: Leah L. Zullig
• 金额: $ 32.28万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 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/10684274
• 关键词: Address; Administrator; Affect; Age; Cancer Care Facilities; Cancer Model; Caring; Clinic; Clinical; Collaborations; Colorectal Cancer; Communication; Communities; Development; Disadvantaged; Economics; Education; Ensure; Environment; Equity; Ethnic Origin; Evaluation; Geography; Health; Health Disparities Research; Health Sciences; Healthcare; Healthcare Systems; Individual; Integrated Health Care Systems; Intervention; Laboratories; Location; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Measures; Medical center; Mission; National Institute on Minority Health and Health Disparities; Neighborhoods; New York; Newly Diagnosed; Oncology; Outcome; Persons; Pharmaceutical Preparations; Pilot Projects; Play; Population Density; Poverty; Price; Provider; Quality of Care; Quality of life; Race; Research; Research Methodology; Social Controls; Universities; Veterans; Veterans Health Administration; Vision; Work; access disparities; built environment; cancer care; cancer diagnosis; cancer health disparity; cancer prevention; care delivery; care outcomes; care systems; contextual factors; disparity reduction; effective intervention; experience; genetic testing; health administration; health care availability; health care service; health communication; health equity; implementation science; innovation; malignant breast neoplasm; medical schools; multidisciplinary; novel; oncology program; racial minority; rural area; rurality; scale up; screening; social; social culture; social determinants; social health determinants; socioeconomics; stakeholder perspectives; survivorship; telehealth; virtual delivery

The Veterans Affairs Health Administration (VA) is the largest integrated health care system in the US, caring for nearly 50,000 veterans with newly diagnosed cancer annually. Equitable, quality care for all veterans is a tenet of the VA healthcare mission. We hypothesize that three particular factors – race, poverty and rurality – are critical in determining access to healthcare, especially telehealth; we refer to these 3 factors as the social determinants of telehealth (SDTH). Approximately 25% of veterans live in rural areas where there may not be adequate local VA cancer care facilities. Unfortunately, these same communities often lack specialized community-based cancer care services as well, making telehealth a necessary option to reduce geographic, economic and racial barriers to quality, timely cancer care. However, little is known about how telehealth delivery for veterans with cancer impacts equitable delivery of quality care, clinical outcomes and experiences of care. As a national integrated health care system focused on quality and equity of cancer care, VA provides an outstanding national laboratory to examine how use of telehealth affects access, quality and equity of care. We will be able to examine how interventions targeting SDTH affect the use of telehealth and how use of telehealth affects quality and equity. We will disseminate this information broadly to help other health care systems understand how best to integrate telehealth into the continuum of cancer care. Using principles of implementation science, Telehealth Research and Innovation for Veterans with Cancer (THRIVE) will leverage Health Disparities Research Framework (HDRF) to advance the science of health equity: building a new model of cancer care delivery addressing SDTH and fulfilling the promise of access to excellent cancer care for veterans regardless of communication format. The Research and Methods Core primarily focuses on health equity, particularly understanding how SDTH impact access to and quality of care. Our multidisciplinary team will achieve THRIVE’s vision by focusing on lung, colorectal, prostate and breast cancers and accomplishing five specific aims: (1) Assess stakeholders’ perspectives of contextual factors impacting cancer telehealth implementation and sustainment at multiple levels; (2) Measure the use of in- person and telehealth communication formats for cancer care throughout VA; (3) Evaluate how the use of telehealth for cancer care, controlling for social determinants of telehealth – specifically race/ethnicity, poverty, and rurality – are associated with cancer care quality; (4) Oversee the selection, development, implementation and evaluation of 10 rapid-cycle pilot studies (2/year) at the intersection of health equity, implementation science and telehealth cancer care; and (5) Frame the affordability of scaling up effective interventions that are identified from the pilot studies.

退伍军人事务健康管理局 (VA) 是美国最大的综合医疗保健系统， 每年为近 50,000 名新诊断癌症的退伍军人提供公平、优质的护理是一项重要任务。 我们抓住了退伍军人事务部医疗保健使命的宗旨——种族、贫困和乡村。 对于确定获得医疗保健（尤其是远程医疗）至关重要；我们将这 3 个因素称为社会因素 远程医疗 (SDTH) 的决定因素 大约 25% 的退伍军人生活在可能没有远程医疗的农村地区。 不幸的是，这些社区往往缺乏专门的退伍军人管理局癌症护理设施。 基于社区的癌症护理服务，使远程医疗成为减少地域、 然而，人们对如何提供远程医疗服务知之甚少。 对于患有癌症的退伍军人来说，影响公平提供优质护理、临床结果和护理体验。 作为一个专注于癌症护理质量和公平性的国家综合医疗保健系统，VA 提供 杰出的国家实验室，研究远程医疗的使用如何影响护理的获取、质量和公平性。 将能够检查针对 SDTH 的干预措施如何影响远程医疗的使用以及远程医疗的使用如何 我们将广泛传播这些信息以帮助其他医疗保健系统。 了解如何最好地将远程医疗融入癌症护理的连续过程中。 实施科学、癌症退伍军人远程医疗研究和创新 (THRIVE) 将利用 促进健康公平科学的健康差异研究框架（HDRF）：建立新模型 癌症护理提供解决 SDTH 问题并履行为患者提供优质癌症护理的承诺 退伍军人，无论沟通方式如何，研究和方法核心主要关注健康。 特别是公平地了解 SDTH 如何影响护理的获取和质量。 我们的多学科团队将重点关注肺、结直肠、前列腺和乳腺癌，以实现 THRIVE 的愿景 癌症并实现五个具体目标：（1）评估利益相关者对背景因素的看法 (2) 测量内部的使用 (3) 评估如何在整个 VA 范围内使用个人和远程医疗通信格式进行癌症护理； 癌症护理的远程医疗，控制远程医疗的社会决定因素——特别是种族/民族、贫困、 和农村——与癌症护理质量相关；(4) 监督选择、开发和实施 以及对 10 项快速循环试点研究（每年 2 项）的评估，这些研究涉及健康公平、实施 科学和远程医疗癌症护理；以及 (5) 制定扩大有效干预措施的负担能力； 从试点研究中确定。