SIMPRO Research Center: Integration and Implementation of PROs for Symptom Manage

SIMPRO 研究中心：症状管理 PRO 的集成和实施

• 批准号: 10898322
• 负责人: Michael James Hassett
• 金额: $ 4.25万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10898322
• 关键词: Adoption; American; Cancer Center; Cancer Patient; Caregivers; Clinic Visits; Clinical; Clinical Trials; Cluster randomized trial; Communities; Disease; Effectiveness; Electronic Health Record; Electronics; Emergency Care; Excision; Goals; Health; Health system; Hospitalization; Impairment; Intervention; Knowledge; Lead; Monitor; Oncology; Operative Surgical Procedures; Outcome; Patient Outcomes Assessments; Patients; Penetration; Phase; Population; Quality of life; Reporting; Research; Research Personnel; Rural; Site; Symptoms; System; acute care; cancer care; cancer diagnosis; cancer surgery; cancer therapy; care delivery; effectiveness evaluation; evidence base; experience; falls; implementation barriers; implementation outcomes; implementation process; implementation strategy; improved; multidisciplinary; palliative chemotherapy; prevent; prototype; reduce symptoms; symptom management; symptomatic improvement

Project Summary In 2018, more than 1.7 million Americans will receive a new cancer diagnosis and nearly 600,000 will die from their disease. Cancer treatments, including major surgical resection and palliative chemotherapy, are associated with frequent adverse symptoms. The primary burden for managing symptoms falls on patients and their caregivers, and there is ample evidence that untreated symptoms impair quality of life, lead to inefficient use of emergency care, avoidable hospitalizations, and even shorten survival. Electronic tracking of patient- reported outcomes (ePROs) between face-to-face clinic visits has been shown to both reduce symptom burden and decrease the need for acute care. Although there is abundant evidence that symptom monitoring can improve cancer care, current experience has been largely limited to single centers or as part of clinical trials. Using ePROs to facilitate symptom control is an attractive strategy but, evidence for effectiveness in different treatment contexts and across varied populations is needed. Further, ePRO tracking systems have not been fully integrated into health systems' electronic health records (EHR) and this deficit prevents them from delivering the maximal benefits of proactive symptom management. To fill gaps in the evidence base about the optimal strategy for deploying ePROs, a multidisciplinary team from 6 health systems have formed the Symptom Management IMplementation of Patient Reported Outcomes in Oncology (SIMPRO) Research Center. SIMPRO's overarching goal is to develop, implement, and evaluate a multi-component ePRO reporting and management system to improve symptom control for patients recovering from cancer surgery or patients receiving palliative chemotherapy in small, rural, and community cancer centers. The Specific Aims of the project are to: (1) Adapt existing ePRO symptom management systems and integrate them into the EHR and routine clinical workflow at six health systems; (2) Determine the effectiveness of an EHR-integrated ePRO symptom management system on health outcomes; and (3) Evaluate the facilitators and barriers to implementation of an EHR-integrated ePRO symptom management system from the patient, clinical and organizational perspectives. Following the adaptation of operational ePRO prototypes and full integration into an EHR, the SIMPRO investigators will conduct a pragmatic cluster randomized trial with stepped wedge rollout to investigate the effectiveness of a symptom monitoring system from a patient, clinician and health system perspective. Across all study phases, the implementation process itself, including ePRO adoption, appropriateness, acceptability, penetration/scalability, and adaptation, will be critically evaluated. This approach will create knowledge that can be used to guide dissemination of ePROs and other interventions to improve cancer care delivery.

项目摘要 2018年，超过170万美国人将接受新的癌症诊断，近60万人将死于 他们的疾病。癌症治疗，包括大手术切除和姑息化疗， 与频繁的不良症状有关。管理症状的主要负担福尔斯在患者身上， 他们的照顾者，有充分的证据表明，未经治疗的症状损害生活质量，导致效率低下 使用紧急护理，可避免的住院治疗，甚至缩短生存时间。电子跟踪患者- 面对面门诊访视之间的报告结局（ePRO）已被证明既可以减少症状负担， 并减少对紧急护理的需求。尽管有大量证据表明，症状监测可以 为了改善癌症护理，目前的经验主要限于单中心或作为临床试验的一部分。 使用ePRO来促进症状控制是一种有吸引力的策略，但在不同地区的有效性证据 需要在不同的治疗背景下和不同的人群中进行。此外，ePRO跟踪系统还没有被 完全集成到卫生系统的电子健康记录（EHR）中，这一缺陷使他们无法 提供主动症状管理的最大益处。 为了填补证据库中关于部署ePRO的最佳策略的空白， 6个卫生系统已经形成了患者报告结果的症状管理实施， 肿瘤学（SIMPRO）研究中心。SIMPRO的首要目标是开发、实施和评估一个 多组件ePRO报告和管理系统，以改善康复患者的症状控制 来自癌症手术或接受姑息化疗的小，农村和社区癌症患者 中心.该项目的具体目标是：（1）调整现有的ePRO症状管理系统， 将其整合到六个卫生系统的EHR和常规临床工作流程中;（2）确定有效性 （3）评估综合电子健康记录的电子病历症状管理系统对健康结果的影响;以及 促进者和障碍，以实施一个EHR集成的ePRO症状管理系统， 患者、临床和组织的观点。在调整ePRO业务原型和 SIMPRO研究人员将进行一项实用的随机分组试验， 阶梯式楔形展开，以调查来自患者、临床医生 卫生系统的观点。在所有研究阶段，实施过程本身，包括ePRO 将对采用、适当性、可接受性、渗透/可扩展性和适应性进行严格评估。 这一方法将创造知识，可用于指导ePRO和其他干预措施的传播 to improve改善cancer癌症care护理delivery交付.

项目成果

ASO Author Reflections: Patient-Reported Outcomes-Bench to Bedside.

ASO 作者感言：患者报告的结果 - 从实验室到临床。

• DOI: 10.1245/s10434-019-07920-9
• 发表时间: 2020
• 期刊: Annals of surgical oncology
• 影响因子: 3.7
• 作者: Ivatury,SrinivasJoga;Wong,SandraL;Schrag,Deborah
• 通讯作者: Schrag,Deborah

eSyM: An Electronic Health Record-Integrated Patient-Reported Outcomes-Based Cancer Symptom Management Program Used by Six Diverse Health Systems.

• DOI: 10.1200/cci.21.00137
• 发表时间: 2022-01
• 期刊: JCO CLINICAL CANCER INFORMATICS
• 影响因子: 4.2
• 作者: Hassett, Michael J.;Cronin, Christine;Tsou, Terrence C.;Wedge, Jason;Bian, Jessica;Dizon, Don S.;Hazard-Jenkins, Hannah;Osarogiagbon, Raymond U.;Wong, Sandra;Basch, Ethan;Austin, Toby;McCleary, Nadine;Schrag, Deborah
• 通讯作者: Schrag, Deborah

Strategies for Implementing an Electronic Patient-Reported Outcomes-Based Symptom Management Program Across Six Cancer Centers.

在六个癌症中心实施基于电子患者报告结果的症状管理计划的策略。

• DOI: 10.21203/rs.3.rs-3879836/v1
• 发表时间: 2024
• 期刊: Research square
• 作者: Hassett,MichaelJ;Dias,Samira;Cronin,Christine;Schrag,Deborah;McCleary,Nadine;Simpson,Jaclyn;Poirier-Shelton,Tiana;Bian,Jessica;Reich,James;Dizon,Don;Begnoche,Megan;Jenkins,HannahHazard;Tasker,Laura;Wong,Sandra;Pearson,Lorett
• 通讯作者: Pearson,Lorett