SymptomCare@Home (SCH): Deconstructing an effective, technology-assisted, symptom management intervention

SymptomCare@Home (SCH)：解构有效的、技术辅助的症状管理干预措施

• 批准号: 9903257
• 负责人: KATHLEEN H MOONEY
• 金额: $ 85.88万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903257
• 关键词: Absenteeism; Accelerometer; Accident and Emergency department; Address; Adherence; Adopted; Adoption; Affect; Cancer Etiology; Cancer Patient; Caring; Characteristics; Chemotherapy-Oncologic Procedure; Clinic Visits; Clinical; Control Groups; Decision Support Systems; Distress; Exercise; Fatigue; Health; Healthcare Systems; Home environment; Individual; Infusion procedures; Intervention; Monitor; Nurse Practitioners; Oncology; Outpatients; Participant; Patient Outcomes Assessments; Patients; Physical activity; Process; Productivity; Provider; Psyche structure; Public Health; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Reporting; Research; Self Management; Severities; Symptoms; System; Technology; Telephone; Testing; Time; Translating; Work; base; cancer care; cancer therapy; care systems; chemotherapy; clinical implementation; clinical practice; control trial; cost; cost effective; cost effectiveness; disabling symptom; eHealth; economic evaluation; evidence based guidelines; experience; follow-up; health care service utilization; hospital services; innovation; multi-component intervention; novel strategies; physical symptom; psychological symptom; public health relevance; reduce symptoms; response; satisfaction; side effect; social; symptom management; telehealth; telehealth systems; treatment arm; treatment as usual; trial design; urgent care; usability; willingness to pay

 DESCRIPTION (provided by applicant): Cancer patients receiving chemotherapy experience multiple poorly controlled symptoms at home in the interim weeks between clinic visits and the next infusion. Their care during this interim time period is suboptimal. Technology can be utilized to bridge the gap between patient symptom needs at home and oncology team response. Automated patient-reported symptom home monitoring and management systems offer a new approach to symptom care. Our research team has developed and tested SymptomCare@Home (SCH). This multi-component automated system monitors daily patient-reported symptoms at home, provides tailored automated self-management coaching based on the specific symptoms reported and transmits unrelieved symptom alert reports to an oncology provider who, using the SCH decision support system provides follow-up telephone-delivered symptom care. We have demonstrated that SCH dramatically reduces physical and psychological symptom severity. However there remain several gaps in translating a successful, multi-component symptom intervention into clinical practice. These include understanding 1) the contribution and value of each part of the intervention so that the active components are selected for clinical implementation and 2) the costs associated with the intervention and its components. Therefore the aims of this project are to deconstruct the SCH symptom monitoring and management system to determine the relative contribution and costs of its components to achieving symptom reduction, maintain general health functioning and reduce healthcare utilization. We will also examine who benefits most and least from the individual components and from the overall system. A 5 group randomized control trial design will be utilized with 750 participants (150/group) beginning a new course of chemotherapy who will call the SCH system daily and report the presence and severity of 11 symptoms throughout a course of chemotherapy or up to 6 months. This study is both significant and innovative because it shifts the current clinical practice paradigm for providing symptom care episodically during clinic visits to an innovative approach that is patient-centric, providing symptom care when and where the patient needs it. The study will address questions not generally asked in multi-component interventions, determining the active ingredients and their costs. Determining the value of new approaches to care such as automated telehealth interventions is essential to the decision process of healthcare systems and payers who decide what to adopt and reimburse. It is also vitally important to patients so that new symptom care innovations are adopted that better meet their needs and dramatically reduce their symptoms.

 描述（由申请人提供）：接受化疗的癌症患者在临床访视和下一次输注之间的中间几周内在家中出现多种控制不良的症状。在这段过渡时期，他们的护理是次优的。技术可用于弥合患者在家症状需求与肿瘤团队响应之间的差距。自动化的患者报告的症状家庭监测和管理系统提供了一种新的方法，症状护理。我们的研究团队已经开发并测试了SymptomCare@Home（SCH）。该多组件自动化系统每天在家中监测患者报告的症状，根据报告的特定症状提供定制的自动化自我管理辅导，并将未缓解的症状警报报告发送给肿瘤提供者，后者使用SCH决策支持系统提供后续电话症状护理。我们已经证明，SCH显着降低身体和心理症状的严重程度。然而，在将成功的多组分症状干预转化为临床实践方面仍存在一些差距。这些包括理解1）干预的每个部分的贡献和价值，以便选择用于临床实施的活性成分，以及2）与干预及其成分相关的成本。因此，本项目的目的是解构SCH症状监测和管理系统，以确定其组成部分的相对贡献和成本，以实现症状减轻，维持一般健康功能和减少医疗保健利用。我们还将研究谁从各个组成部分和整个系统中受益最多，谁受益最少。将采用5组随机对照试验设计，750例受试者（150例/组）将开始新的化疗疗程，这些受试者将在整个化疗疗程或长达6个月内每天致电SCH系统，报告11种症状的存在和严重程度。这项研究是既有意义和创新，因为它改变了目前的临床实践模式，提供症状护理时，在诊所访问 该研究将解决多组分干预中通常不问的问题，确定活性成分及其成本。确定新的护理方法（如自动远程医疗干预）的价值对于医疗保健系统和决定采用和报销的付款人的决策过程至关重要。这对患者也至关重要，以便采用新的症状护理创新，更好地满足他们的需求并大大减少他们的症状。