Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

自冠状病毒大流行以来，远程医疗的迅速普及不仅突出了 远程医疗可以改善一些人的医疗服务和质量，但也可以改善远程医疗如何加剧“数字医疗”， 鸿沟”，加大了保健方面的差距，并强调需要注重保健公平。社会，经济， 环境和结构因素统称为健康的社会决定因素（SDH）--解释了 30-50%的健康结果的方差，远远超过10-20%归因于医疗保健。为了 为了实现健康公平，必须以这些SDH为目标。我们将特别关注种族/民族、贫困和 农村地区及其如何影响远程保健的使用，我们称之为远程保健的社会决定因素。 退伍军人健康管理局（VA）是美国最大的综合医疗保健系统， 为171个医疗中心和1,112个门诊点的900万患者提供服务。VA提供了独特的机会 研究SDTH如何影响整个医疗保健系统中远程医疗对癌症的使用， 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。所有三个蓬勃发展的PI的专家在实施科学，并将使用NIMHD健康 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保健的情况，并探索和了解差异。 我们建议建立一个名为癌症退伍军人远程医疗研究和创新（THRIVE）的中心， 总体目标是双重的：1）了解SDTH如何影响癌症远程医疗的提供，2） 制定解决SDTH的方法，从而改善所有患者的癌症护理的可及性和质量。 THRIVE将专注于VA中四种非常重要和流行的癌症：肺癌，结肠癌，前列腺癌和乳腺癌。 我们的研究结果将是非常有价值的了解如何远程医疗实施影响的质量， 癌症护理的整个人口，以及如何VA和其他美国卫生系统可以利用远程医疗， 改善癌症结果和健康公平性。本中心的具体目标是：（1）有效管理所有 的组成部分，包括协调，沟通，财政管理，招聘和 （2）确定SDTH对癌症远程保健使用差异的影响 保健和保健的总体质量，并制定和测试执行战略，以减少差距， （研究和方法核心）;（3）建立一个高功能的学习网络，以促进对 癌症远程医疗（临床实践网络）;（4）进行一项试验， 多层次虚拟肿瘤学计划，促进参与远程医疗和减少SDTH相关护理 差异（实用试验）;（5）在虚拟护理中培养下一代肿瘤学研究人员， 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.