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

项目摘要 2018年，超过170万美国人将被诊断为新的癌症，近60万人将死于 他们的病。癌症的治疗，包括大手术切除和姑息化疗，是 与频繁的不良症状有关。管理症状的主要负担落在患者和 他们的照顾者，而且有充分的证据表明，未经治疗的症状损害了生活质量，导致效率低下 使用紧急护理，避免住院，甚至缩短生存时间。电子追踪病人- 面对面就诊之间的报告结果(EPRO)已被证明既能减轻症状负担 并减少对急性护理的需求。尽管有大量证据表明症状监测可以 在改善癌症治疗方面，目前的经验在很大程度上仅限于单个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个有吸引力的策略，但在不同的 需要在不同的人群中进行治疗。此外，ePRO跟踪系统还没有 完全集成到卫生系统的电子健康记录(EHR)中，这一缺陷阻止了他们 提供主动症状管理的最大好处。 为了填补关于部署ePRO的最佳战略的证据基础中的空白，来自 年，6个卫生系统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的总体目标是开发、实现和评估 多组件ePRO报告和管理系统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型、农村和社区癌症患者 中锋。该项目的具体目标是：(1)调整现有的ePRO症状管理系统和 将其纳入六个卫生系统的电子健康记录和常规临床工作流程；(2)确定有效性 与eHR整合的ePRO症状管理系统对健康结果的影响；以及(3)评估 实施EHR集成的ePRO症状管理系统的促进者和障碍 患者、临床和组织的观点。在改编运营ePRO原型和 完全整合到EHR中，simPRO调查员将进行务实的整群随机试验 阶梯式楔形展开以调查来自患者、临床医生的症状监测系统的有效性 和卫生系统的观点。在所有研究阶段，实施过程本身，包括ePRO 将对采用率、适当性、可接受性、渗透性/可扩展性和适应性进行严格评估。 这一方法将创造可用于指导传播ePRO和其他干预措施的知识 以改善癌症护理服务。

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.