Perioperative Telemonitoring to Optimize Cancer Care and Outcomes

项目总结 这项建议的总体目的是进行一项远程围手术期的试点随机试验。 远程监护干预以改善以患者为中心的结果、手术结果和医疗资源 在英语和西班牙语患者计划接受重大腹部胃肠道癌治疗时使用 做手术。这项研究是至关重要的，因为癌症手术后，患者的 功能能力、症状增加和生活质量总体急剧下降，大多数 术后护理和康复在家中进行。在家的时候，身体机能可能会在 外科团队得到通知，导致多达三分之一的患者因并发症而出现症状 可能需要重新入院。远程监护围手术期症状，包括生命体征、体重、 所采取的步骤和患者报告的结果允许有机会在围手术期进行干预 减轻并发症和再入院的严重程度。干预是围手术期的测量 两组的参数，以护理分诊为干预措施，以拦截和改善并发症 患者报告了结果。我们将使用1：1随机化对干预进行试点测试，以实现以下目标 具体目标：具体目标1：评估远程围手术期手术的可行性、保留性和可接受性 远程监测干预，以a)同意参与的患者的百分比衡量；b)完成 70%的远程监测；以及c)通过结构化的离职面谈报告对干预措施的满意度； 具体目标2：确定远程围手术期远程监护干预的初步疗效 手术结果、医疗保健利用率、优点和功能恢复。这项建议具有创新性，因为 我们是首批也是少数几个研究将以患者为中心的结果转化为可操作的方法的人之一。 除了使用现有的数字设备外，还使用客观和主观措施进行癌症术后护理 医疗基础设施(AetonixTM)利用“真实世界”平台扩展到外科肿瘤学。这个 包括外科肿瘤学(Melstrom)和护理学(Sun)专业知识的跨学科团队是 非常适合进行这项研究。这项提议意义重大，具有高度的科学严谨性和成果 对癌症患者、临床医生、医疗系统和患者的围手术期护理至关重要 美国国家癌症研究所。这项研究将解决围术期知识的一个关键缺口 远程监测客观和主观数据将改善围手术期癌症的预后和转归 在医院环境之外的护理。我们的长远目标是在多个地点进行第三期试验。 干预以建立有效性。

PROJECT SUMMARY The overall purpose of this proposal is to conduct a pilot randomized trial of a remote perioperative telemonitoring intervention to improve patient-centered outcomes, surgical outcomes and healthcare resource use in English and Spanish-speaking patients scheduled to undergo major abdominal gastrointestinal cancer surgery. This research is critical because after cancer surgery, patients experience abrupt declines in functional capacity, increase in symptoms and an overall dramatic decline in quality of life with the majority of postoperative care and recovery taking place at home. While at home, physical function can decline prior to the surgical team being notified leading up to one third of patients becoming symptomatic from a complication that may require readmission. Telemonitoring of symptoms in the perioperative period including vital signs, weight, steps taken and patient reported outcomes allows for an opportunity to intervene in the perioperative period to mitigate severity of complications and readmissions. The intervention is perioperative measurement of parameters in both groups with a nursing triage as the intervention to intercept complications and to improve patient reported outcomes. We will pilot test the intervention using a 1:1 randomization to pursue the following specific aims: Specific Aim 1: Assess the feasibility, retention, and acceptability of the remote perioperative telemonitoring intervention as measured by the percentage of patients who a) agree to participate; b) complete >70% of the telemonitoring; and c) report satisfaction with the intervention through structured exit interviews; Specific Aim 2: Determine the preliminary efficacy of the remote perioperative telemonitoring intervention on surgical outcomes, healthcare utilization, PROs, and functional recovery. This proposal is innovative because we are among the first and few to study methods of transforming patient-centered outcomes into actionable postoperative cancer care using objective and subjective measures in addition to using an existing digital health infrastructure (AetonixTM) leveraging a “real world” platform for expansion into surgical oncology. The interdisciplinary team which includes expertise in surgical oncology (Melstrom) and nursing science (Sun) is uniquely suited to conduct this research. The proposal is significant, with high scientific rigor and outcomes that are of critical importance in perioperative care to cancer patients, clinicians, healthcare systems and the National Cancer Institute. This research will address a critical gap in knowledge of how perioperative telemonitoring of objective and subjective data will improve outcomes and transitions of perioperative cancer care outside of the hospital setting. Our long-term objective is to conduct a multi-site, Phase III trial of the intervention to establish effectiveness.