Evaluating the implementation and impact of navigator-delivered ePRO home symptom monitoring and management

评估 navigator 提供的 ePRO 家庭症状监测和管理的实施和影响

• 批准号: 10401491
• 负责人: Gabrielle Rocque
• 金额: $ 62.01万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-04 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10401491
• 关键词: Accident and Emergency department; Address; Administrator; Admission activity; Adult; Advanced Malignant Neoplasm; African American population; Alabama; Cancer Model; Cancer Patient; Caring; Client satisfaction; Clinical; Clinical Medicine; Clinical Nursing; Collaborations; Consolidated Framework for Implementation Research; Data; Data Sources; Distress; Effectiveness; Emergency department visit; Financial Support; Funding; Future; Goals; Health Services Research; Health system; Healthcare; Home; Hospitalization; Hospitals; Human Resources; Hybrids; Individual; Infrastructure; Institution; Intensive Care Units; Intervention; Interview; Knowledge; Letters; Maintenance; Malignant Neoplasms; Malignant neoplasm of lung; Measures; Medical Care Team; Medicare; Mental Depression; Methodology; Minority; Mission; Modeling; Monitor; Nurses; Nursing Services; Oncology; Outcome; Outcomes Research; Patient Care; Patient Outcomes Assessments; Patient Participation; Patients; Penetrance; Penetration; Perception; Physicians; Population; Positioning Attribute; Provider; Public Health; Quality of life; Randomized Controlled Trials; Reporting; Research; Research Personnel; Research Support; Resources; Services; Site; Surveys; Symptoms; System; Technology; Testing; Time; United States National Institutes of Health; Universities; Vendor; Visit; Vulnerable Populations; Work; adverse outcome; base; cancer care; cancer survival; cancer therapy; chemotherapy; cost; disability; evidence base; experience; functional status; health care service utilization; hybrid type 2 design; implementation evaluation; implementation framework; implementation intervention; implementation outcomes; implementation science; implementation strategy; implementation trial; improved; innovation; intervention delivery; patient home care; patient population; payment; population based; provider adoption; randomized trial; response; rural dwellers; scale up; socioeconomic disadvantage; standard of care; success; symptom management; treatment duration; week trial

PROJECT SUMMARY Randomized controlled trials by Basch (collaborator) and colleagues demonstrated that weekly electronic home-based PRO symptom monitoring with automated alerts to clinicians (Home ePRO) in cancer patients was associated with reduced healthcare utilization, improved quality of life, and increased overall survival. However, these trials were administered using infrastructure supported by research funding. A knowledge gap remains about optimal implementation strategies for and effectiveness of Home ePROs in real-world settings. To address this gap, investigators from two institutions will conduct a large-scale, population-based implementation of an evidence-based Home ePRO intervention for all adult cancer patients receiving chemotherapy, including vulnerable populations such as African Americans, rural residents, and socioeconomically disadvantaged individuals. This implementation will leverage infrastructure from Medicare's payment reform projects (Oncology Care Model, Oncology Care First Model), which require and financially support patient navigators, a natural workforce for Home ePRO implementation. Our hypothesis is that the deployed implementation strategies will result in successful navigator-delivered Home ePRO, which will improve both patient and health system outcomes. Using the Consolidated Framework for Implementation Research (CFIR), this hypothesis will be tested using a hybrid type 2 design with three specific aims: 1) evaluate implementation of navigator-delivered Home ePRO for all cancer patients across multiple practice sites; 2) examine the barriers, facilitators, and implementation strategies used in implementing navigator- delivered Home ePRO; and 3) assess the impact of Home ePRO on clinical and utilization outcomes. In Aim 1, Home ePRO will be evaluated using implementation outcomes (service penetrance, provider adoption/penetration, intervention fidelity). In Aim 2, we will gauge patient and healthcare team perceptions of barriers and facilitators of navigator-led Home ePRO, implementation strategies used to address these barriers, implementation strategy fidelity, and perception of implementation strategy ability to address barriers using an iterative qualitative analysis. In Aim 3, patient-level outcomes (functional status, distress, depression, healthcare utilization, cost, survival) will be evaluated using real-world data sources. The project is innovative because it will be the first study to evaluate real-world implementation of navigator-led Home ePRO for all cancer patients receiving chemotherapy, an approach that is both immediately scalable and sustainable within value-based payment models. The proposed research is significant because it is expected to demonstrate successful implementation of navigator-delivered Home ePRO and effectiveness of the ePRO intervention on diverse patient populations. Furthermore, the project will generate an implementation blueprint of successful implementation strategies that can be easily applied to other patient-reported outcomes, with the potential to positively impact patient care as health care transitions to a value-based system.

项目摘要 Basch（合作者）及其同事的随机对照试验表明，每周电子 在癌症患者中进行基于家庭的PRO症状监测，并向临床医生发出自动警报（家庭ePRO） 与降低医疗保健利用率、改善生活质量和增加总生存率相关。 然而，这些试验是使用研究资金支持的基础设施进行的。知识缺口 仍然是关于家庭ePRO在现实环境中的最佳实施策略和有效性。 为了解决这一差距，来自两个机构的研究人员将进行一项大规模的、基于人群的 为所有接受治疗的成年癌症患者实施基于证据的家庭ePRO干预 化疗，包括弱势群体，如非洲裔美国人，农村居民， 社会经济弱势群体。该实施将利用医疗保险的基础设施， 支付改革项目（肿瘤护理模式，肿瘤护理第一模式），需要和财政 支持患者导航员，这是家庭ePRO实施的天然劳动力。我们的假设是 部署的实施战略将导致导航器成功交付Home ePRO，这将 改善患者和卫生系统的结果。使用综合执行框架 研究（CFIR），将使用具有三个具体目标的混合2型设计来测试该假设：1） 在多个实践中评估所有癌症患者导航仪提供的Home ePRO的实施情况 网站; 2）检查的障碍，促进者，并在实施导航使用的实施策略- 交付的Home ePRO;以及3）评估Home ePRO对临床和使用结果的影响。在目标1中， 家庭ePRO将使用实施结果（服务质量、提供商）进行评估 采用/渗透，干预保真度）。在目标2中，我们将评估患者和医疗团队对以下方面的看法： 导航器引导的家庭电子PRO的障碍和促进因素，用于解决这些问题的实施策略 障碍、实施战略的忠诚度以及对实施战略解决障碍的能力的看法 使用迭代定性分析。在目标3中，患者水平的结局（功能状态、痛苦、抑郁， 医疗保健利用率、成本、生存率）将使用真实世界数据源进行评价。该项目具有创新性 因为这将是第一项评估导航仪主导的家庭ePRO在现实世界中实现的研究 接受化疗的癌症患者，这是一种既可立即扩展又可持续的方法， 基于价值的支付模式。这项研究意义重大，因为它有望证明 成功实施导航器交付的家庭电子PRO和电子PRO干预的有效性， 不同的患者群体。此外，该项目将产生一个成功的实施蓝图， 实施策略，可以很容易地应用于其他患者报告的结果，有可能 随着医疗保健向基于价值的系统过渡，对患者护理产生积极影响。