Clinical Practice Network - Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

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SUMMARY The Veterans Health Administration (VA) is the largest integrated health care system in the United States, providing care at 1,293 health care facilities, including 171 medical centers and 1,112 outpatient sites and serving approximately 9 million enrolled Veterans. It is also one of the largest educational systems, with 70% of physicians having received some of their training in VA. Reflecting its tripartite mission of patient care, education and research, VA also funds more research than any other US health care system. While most honorably discharged veterans are eligible to use VA for care, it is disproportionately used by those without other health insurance. As a result, VA acts in part as a national “safety net” health system for veterans. For this reason, and many others, health equity has always been an important goal for VA healthcare. Oncology care in VA is multidisciplinary, with care coordinated between primary care, hematology/ oncology, surgical oncology, radiation oncology and others. Primary care is based on the patient-centered medical home model, so the primary care team typically includes nursing, pharmacy, social work and psychology. This multidisciplinary care is facilitated by a uniform national electronic health record (EHR) system and a common platform for all virtual care in VA. With its continual focus on quality improvement, patient-centered care and health equity, VA health care system will serve as the setting for the innovative tele-oncology research proposed by this center, Telehealth Research and Innovation for Veterans with Cancer (THRIVE). The Clinical Practice Network Core will act as the Clinical Coordinating Center for THRIVE. It will be responsible for: 1) organizing patient recruitment and identification; 2) serve as the “tech center” for coordinating all technology-focused activities related to the center projects; and 3) serve as the care coordination center such that all care across the sites are coordinated via the network. We already have longstanding relationships with VA National Oncology Program Office and VA Office of Connected Care, which respectively oversee all oncologic care and all virtual care. The Clinical Practice Network Core will further strengthen our connections by serving as liaison with both national VA program offices and with individual study sites. Our specific aims are to: (1) Create a virtual, decentralized clinical practice network; (2) Leverage informatics for the equitable recruitment and enrollment of cancer patients across social strata; and (3) Create a learning research environment that incorporates assessments and iterative process improvement.