Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

自冠状病毒大流行以来，远程保健的迅速普及不仅突显了 远程医疗改善了一些人的机会和护理质量，但远程医疗也如何加剧了 差距，“日益扩大的保健差距，并强调有必要注重卫生公平。社会、经济、 环境、和结构性因素统称为健康的社会决定因素(SDH)--占 健康结果差异的30%-50%，远远超过归因于医疗保健的10%-20%。为了 要实现健康公平，瞄准这些SDH至关重要。我们将特别关注种族/族裔、贫困和 农村及其如何影响远程医疗的使用，我们称之为远程医疗的社会决定因素(SDTH)。 退伍军人健康管理局(VA)是美国最大的综合医疗保健系统，提供 到171个医疗中心和1112个门诊点的900万名患者。弗吉尼亚州提供了一个独特的机会 为了研究SDTH如何影响在整个医疗保健系统中平等获得和使用远程医疗治疗癌症的情况 而不注重报销。因此，整个VA系统将作为我们的临床实践网络 这个中心。所有三个Thrive PI都是实施科学方面的专家，将使用NIMHD Health 差异研究框架和实施研究综合框架以指导我们的 了解为癌症患者提供远程医疗服务的情况，并探索和了解差异。 我们建议成立一个名为癌症退伍军人远程医疗研究和创新(Thrive)的中心，其 总体目标有两个：1)了解SDTH如何影响癌症远程医疗的提供；2) 制定应对SDTH的方法，从而改善所有患者获得癌症护理的机会和质量。 Thrive将专注于退伍军人管理局内四种非常重要和普遍的癌症：肺癌、结肠癌、前列腺癌和乳腺癌。 我们的发现对于理解远程医疗实施如何影响 为整个人群提供癌症护理，以及退伍军人管理局和其他美国卫生系统如何利用远程医疗来 改善癌症结果和健康公平。我们对该中心的具体目标是：(1)高效管理所有 Thrive的组成部分，包括协调、沟通、财务管理、征聘和 传播(行政核心)；(2)确定SDTH对癌症远程保健使用差异的影响 关于护理和整体护理质量，并制定和测试执行战略，以缩小差距 (研究和方法核心)；。(3)创建一个高功能的学习网络，以促进对 癌症远程保健(临床实践网络)；(4)进行一项试验，评估综合、 促进远程医疗参与和减少SDTH相关护理的多层次虚拟肿瘤学计划 差异(实用试验)；和(5)培训下一代虚拟护理和肿瘤研究人员 健康公平。

The rapid uptake of telehealth since the coronavirus pandemic has highlighted not only the potential for telehealth to improve access and quality of care for some but also how telehealth can exacerbate the “digital divide,” increasing disparities in care and highlighting the need to focus on health equity. Social, economic, environmental, and structural factors collectively known as social determinants of health (SDH) – account for 30-50% of the variance in health outcomes, far more than the 10-20% ascribed to health care. In order to achieve health equity, it is crucial to target these SDH. We will particularly focus on race/ethnicity, poverty and rurality and how they affect use of telehealth, which we refer to as social determinants of telehealth (SDTH). The Veterans Health Administration (VA) is the largest integrated health care system in the US, providing care to 9 million patients across 171 medical centers and 1,112 outpatient sites. VA provides a unique opportunity to examine how SDTH affect use of telehealth for cancer across a health care system with equal access and without focus on reimbursement. Therefore, the entire VA system will serve as our clinical practice network for this Center. All three THRIVE PI’s are experts in implementation science and will use the NIMHD Health Disparities Research Framework and the Consolidated Framework for Implementation Research to guide our understanding of telehealth care delivery for patients with cancer and to explore and understand disparities. We propose a Center called Telehealth Research and Innovation for Veterans with Cancer (THRIVE), whose overarching aim is two-fold: 1) to understand how SDTH impact the delivery of telehealth for cancer and 2) to develop methods to address SDTH and thereby improve access and quality of cancer care for all patients. THRIVE will focus on four highly important and prevalent cancers within VA: lung, colon, prostate, and breast. Our findings will be extremely valuable in understanding how telehealth implementation affects the quality of cancer care for the entire population and how VA and other US health systems can leverage telehealth to improve cancer outcomes and health equity. Our Specific Aims for this Center are: (1) efficiently manage all components of THRIVE, including coordination, communication, fiscal management, recruitment and dissemination (Administrative Core); (2) Identify the impact of SDTH on disparities in telehealth use for cancer care and on overall quality of care and to develop and test implementation strategies to mitigate disparities (Research and Methods Core); (3) Create a high functioning learning network to facilitate research on telehealth for cancer (Clinical Practice Network); (4) conduct a trial assessing the impact of a comprehensive, multilevel virtual oncology program on promoting engagement with telehealth and reducing SDTH-related care disparities (Pragmatic Trial); and (5) Train the next generation of oncology researchers in virtual care and health equity.