Improving Thoracic Surgical Care using electronic Patient-Reported Outcomes (ePROs)

使用电子患者报告结果 (ePRO) 改善胸部外科护理

• 批准号: 10545184
• 负责人: Gita Natwar Mody
• 金额: $ 20.22万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10545184
• 关键词: Address; Adoption; Area; Award; Awareness; Biometry; COVID-19; Cancer Patient; Caring; Cessation of life; Chest; Chronic; Clinic; Clinic Visits; Clinical; Clinical Trials; Clinical effectiveness; Colorectal Surgery; Complex; Complication; Computer software; Consolidated Framework for Implementation Research; Coupled; Data; Data Analyses; Data Sources; Dedications; Dyspnea; Early Diagnosis; Effectiveness; Electronics; Eligibility Determination; Emergency department visit; Enrollment; Ensure; Environment; Excision; Feedback; Frequencies; Future; Goals; Health Services Research; Home; Individual; International; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lung; Lung diseases; Measurement; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; Monitor; National Heart, Lung, and Blood Institute; North Carolina; Nurse Practitioners; Oncology; Operative Surgical Procedures; Outcome Measure; Outcomes Research; Pain; Patient Monitoring System; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Population; Positioning Attribute; Postoperative Care; Postoperative Period; Prospective Studies; Protocols documentation; Provider; Qualitative Research; Quality of life; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recovery; Repeat Surgery; Reporting; Research; Research Infrastructure; Research Methodology; Resources; Risk; Role; Schedule; Scientist; Structure; Surgeon; Surveys; Symptoms; System; Testing; Thoracic Surgeon; Thoracic Surgical Procedures; Time; Training; Universities; Use Effectiveness; Work; career; clinical center; design; effectiveness outcome; electronic patient reported outcomes; health care service utilization; health data; health information technology; high risk; hospital readmission; implementation barriers; implementation evaluation; implementation fidelity; implementation framework; implementation outcomes; implementation science; implementation/effectiveness; improved; improved outcome; mortality; novel; participant enrollment; practice factors; prevent; randomized trial; real world application; remote monitoring; respiratory; response; routine care; skills; success; surgery outcome; surgical risk; symptom management; virtual healthcare

Project Summary/Abstract Severe complications after thoracic surgery are common and lead to increased readmissions and mortality. The early symptoms of developing complications may not be detected by the usual scheduled postoperative care before they worsen and become severe. Postoperative care can be done remotely and in real-time with automated systems that electronically deliver surveys to patients to directly capture patient- reported outcomes and send alerts to providers for concerning responses (ePROs). ePROs improve quality of life, healthcare utilization, and survival in several large clinical trials as well as have emerging evidence of clinical effectiveness in real-world applications in oncology patients. ePROs also have been shown to be feasible for symptom management in small trials of thoracic and colorectal surgery patients. These data suggest ePROs have the potential to improve care after thoracic and other high-risk surgery. However, there are no widely implemented ePRO systems in routine surgical care, despite evidence from other settings to support the value of systematically identifying and then addressing anticipated barriers to implementation in the ePRO design. Current gaps in knowledge to designing ePROs for use in surgical care include identifying optimal survey/alert features and workflow, barriers to routine use, and clinical effectiveness. The candidate for this career development award, Dr. Mody, is a thoracic surgeon whose career goal is to improve clinical and patient-centered outcomes for patients with chronic lung conditions requiring surgery. The proposed award will build on her prior MPH that included formal training in biostatistics and health services research and will provide advanced training in areas necessary for her to achieve her career goals. Specifically, during the award period Dr. Mody will receive training in qualitative data analysis including mixed methods and implementation science research methods. Dr. Mody will perform a prospective study of implementation and effectiveness outcomes in thoracic surgery clinics using postoperative ePROs. To ensure her success, an interdisciplinary team of mentors and advisors with complementary expertise have been enlisted including Dr. Ethan Basch (clinical trials in oncology, PRO research), Dr. Jennifer Leeman (implementation, qualitative research), Dr. Antonia Bennett (quality of life measurement, qualitative research), Dr. Andrea Pusic (clinical trials in surgery, PRO research), Dr. Angela Smith (surgery, health information technology for PRO measurement), and Dr. Angela Stover (implementation of PROs). By the end of the award period, Dr. Mody will have the necessary preliminary data and training to successfully perform a large scale randomized controlled trial to evaluate the implementation and effectiveness of an ePRO system in cardiothoracic surgery patients. Designing and evaluating such a system in thoracic surgery patients first is important as they serve as a model for the increasing numbers of medically complex patients requiring invasive treatments for chronic conditions and for whom ePROs may substantially improve outcomes.

项目总结/摘要 胸外科手术后的严重并发症是常见的，并导致增加再入院， mortality.发展中的并发症的早期症状可能无法通过通常的计划检测到 在病情恶化并变得严重之前进行术后护理。术后护理可以远程进行， 实时与自动化系统，以电子方式提供调查给病人，直接捕捉病人- 报告结果，并向提供者发送警报，以获得相关响应（ePRO）。ePRO提高质量 在几项大型临床试验中， 在肿瘤患者的实际应用中的临床有效性。ePRO还被证明是 在胸外科和结直肠手术患者的小型试验中进行症状管理是可行的。这些数据 这表明ePRO有可能改善胸外科和其他高风险手术后的护理。但 在常规外科护理中没有广泛实施ePRO系统，尽管其他环境的证据表明， 支持有系统地查明并随后处理预期的执行障碍的价值， ePRO设计目前在设计用于外科护理的ePRO方面的知识差距包括： 最佳的调查/警报功能和工作流程、常规使用的障碍和临床有效性。 本次职业发展奖的候选人莫迪医生是一名胸外科医生，其职业目标是 改善慢性肺部疾病患者的临床和以患者为中心的结局， 手术拟议的奖项将建立在她之前的公共卫生硕士学位，其中包括生物统计学的正式培训， 卫生服务研究，并将提供先进的培训，在必要的领域，她实现她的职业生涯 目标.具体而言，在授予期间，Mody博士将接受定性数据分析培训，包括 混合方法和实施科学的研究方法。Mody博士将进行前瞻性研究， 胸外科诊所使用术后ePRO的实施和有效性结果。确保 她的成功，一个跨学科的导师和顾问团队与互补的专业知识， 包括Ethan Basch博士（肿瘤学临床试验，PRO研究），Jennifer Leeman博士 Antonia班尼特博士（生活质量测量，定性研究）， 博士Andrea Pusic（外科临床试验，PRO研究），Angela Smith博士（外科，健康信息 PRO测量技术）和Angela秸秆博士（PRO的实施）。结束时 获奖期间，博士么将有必要的初步数据和培训，成功地执行一个大的 一项规模随机对照试验，以评估电子病历系统的实施和有效性， 心胸外科病人首先在胸外科患者中设计和评估这样的系统， 重要的是，他们作为一个模型，越来越多的医疗复杂的病人，需要 慢性疾病的侵入性治疗，ePRO可显著改善其结局。