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：
10454678
负责人：
DANIL V. MAKAROV
金额：
$ 32.07万
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/10454678
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 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 implementation study effectiveness implementation trial effectiveness testing experience 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，结直肠癌，前列腺和乳房 - 几乎占男性癌症死亡的一半和美国的妇女。远程医疗的社会决定者（SDTH），例如种族/种族，贫困和乡村，单独，添加或协同组合在访问和癌症护理的结果经常考虑观察到的癌症护理分布。退伍军人健康管理（VA）是美国最大的癌症护理综合提供商，并提供最先进的状态对数百万退伍军人的癌症护理。然而，即使在VA内，通常以其平等获取护理模型的访问而受到赞誉癌症护理的差异持续存在。但是，尽管VA为有SDTH Drive Healthcare的人口服务差异，它还利用了综合的国家单付款人系统的优势，例如Care 协调和远程医疗，以改善健康公平。在肿瘤学中使用telehelath的宽度既可以构成挑战，又会扩大访问权限和机会改善护理。但是，在某些情况下，对远程医疗的依赖可能会扩大有限的访问能力。关于将远程医疗整合到的最佳方法存在的主要知识差距整个护理连续性的肿瘤学实践。我们的总体目的是提高质量和公平性通过利用经验教训的经验，使用远程医疗治疗退伍军人， VA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的有效性，VA 国家电视课程（NTO），多级远程医疗人口健康管理计划。我们提议对NTO的阶梯楔子，簇随机，混合有效性研究研究在弗吉尼亚州诊断为前列腺，肺，结肠和乳腺癌的退伍军人。使用NIMHD健康差异研究框架，我们将采用混合方法来探索NTO之间SDTH的关联 1）服务交付结果，2）分层癌症和3）实施结果。具体而言，务实试验的目的是：（1）评估全面的多级虚拟的效果肿瘤学计划旨在促进利益相关者（患者，提供者，管理员）癌症的远程医疗参与 SDTH的护理经验；（2）评估全面的多层次虚拟肿瘤学计划的效果 SDTH诊断为肺，结直肠癌，前列腺和乳腺癌的退伍军人的癌症护理质量；（3）确定全面的多级电视课程的影响和成本。我们提议的混合有效性实施试验，以评估全面的虚拟肿瘤学计划促进远程医疗的参与和健康公平具有较高的可伸缩性和公共卫生影响的潜力弗吉尼亚州内外。