Implementing the NYU Electronic Patient Visit Assessment (ePVA) for Head and Neck Cancer In Rural and Urban Populations

在农村和城市人群中实施纽约大学电子患者就诊评估 (ePVA) 来评估头颈癌

• 批准号: 10715478
• 负责人: JANET H VAN CLEAVE
• 金额: $ 73.35万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10715478
• 关键词: Adoption; Architecture; Cancer Center; Clinical; Combined Modality Therapy; Comprehensive Cancer Center; Deglutition; Diagnosis; Documentation; Early Diagnosis; Effectiveness; Electronic Health Record; Electronics; Emergency department visit; Enteral Feeding; Food; Fox Chase Cancer Center; Goals; Head and Neck Cancer; Healthcare; Hospitalization; Human; Individual; Inequality; Institution; Intervention; Interview; Investigation; Kansas; Knowledge; Literature; Logic; Maintenance; Malignant Neoplasms; Measures; Medical; Medical center; Methods; Mission; Monitor; National Cancer Institute; New York; Oncology; Operative Surgical Procedures; Outcome; Pain; Participant; Patients; Persons; Population; Population Heterogeneity; Public Health; Radiation therapy; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reporting; Research; Rural Population; Scientific Advances and Accomplishments; Site; Smell Perception; Social Functioning; Standardization; Symptoms; Taste Perception; Technology; Time; United States; United States Centers for Medicare and Medicaid Services; Universities; Urban Population; Variant; Visit; acute care; arm; cancer care; care systems; chemotherapy; chronic pain; common symptom; completed suicide; cost; data integration; design; digital health; effectiveness evaluation; effectiveness testing; electronic health record system; experience; head and neck cancer patient; health related quality of life; hybrid type 1 study; implementation strategy; improved; interoperability; patient engagement; patient oriented; point of care; primary endpoint; primary outcome; randomized, clinical trials; rural setting; satisfaction; secondary outcome; statistics; support tools; symptom management; symptomatic improvement; theories; tool; treatment as usual; urban setting; usability; usual care arm

ABSTRACT Approximately 66,000 individuals will be diagnosed with head and neck cancer (HNC) in the United States (US) in 2022. Most patients with HNC are treated aggressively with multi-modal therapies that have improved survival but at a human cost of substantial symptom burden, decreased health-related quality of life (HRQoL), and extensive acute care use. Symptom management for patients with HNC is critical. However, up to 50% of patients' symptoms go undetected and electronic health records (EHR) documentation of symptoms is incomplete. Ground-breaking research shows patient-reported symptom (PRO) monitoring during cancer care is associated with improved symptom control, decreased acute care use, and longer survival. Yet, a closer investigation of the literature finds the effects of PROs on cancer outcomes vary depending on implementation. Reasons for variations in PRO implementation include limited integration with electronic health records (EHR), inequality in access, and lack of standardized approaches, creating barriers to widespread implementation of PROs. We developed the NYU Electronic Patient Visit Assessment (ePVA) for HNC as a valid, reliable PRO that has evolved into a clinical support tool for early detection of uncontrolled symptoms. The ePVA provides a global picture of the patient's condition automated to clinicians at point-of-care, enabling real-time interventions. We completed a pilot randomized clinical trial of the ePVA in 32 patients with HNC undergoing radiation therapy (RT) with or without chemotherapy, and found those assigned to the ePVA+Usual Care Arm reported significantly less severe HNC symptoms (p<.05) and acute care use (p<.001) than those assigned to the Usual Care Arm. Our objective in this proposal is to identify implementation strategies optimizing the effectiveness of the ePVA to improve HNC outcomes in real-world settings and explore integrating the ePVA with the EHR architecture for scalability and equality in access. To achieve this objective, we will conduct a mixed methods hybrid type I study at three National Cancer Institute-Designated Comprehensive Cancer Centers serving diverse populations in rural and urban settings (New York University, University of Kansas Cancer Center, Fox Chase Cancer Center) using the RE-AIM framework. For participants with HNC undergoing RT with or without chemotherapy, the specific aims are: 1) (Quantitative) Determine the effect of the Electronic Patient Visit Assessment (ePVA) on HNC symptoms (primary outcomes), pain, HRQoL, and acute care use (secondary outcomes) in a two-arm (usual care vs. ePVA+usual care) multisite randomized clinical trial (n=270); 2) (Qualitative) Examine HNC patients’ and clinicians’ perspectives on patient, clinician, and organization facilitators and barriers to the ePVA’s reach, adoption, effectiveness, and maintenance; 3) (Integrated) Identify implementation strategies optimizing ePVA’s reach, adoption, effectiveness, and maintenance; Exploratory Aim: Explore the usability of the integration of ePVA with EHR systems (n=30). The long-term goal of this research is to identify implementation and technology standards for effective, widespread use of the ePVA that apply to all PROs in cancer care.

摘要 在美国，大约有66，000人将被诊断患有头颈癌（HNC） 2022年大多数HNC患者积极接受多模式治疗，提高了生存率 但以大量症状负担、健康相关生活质量（HRQoL）下降和 广泛的急性护理使用。HNC患者的症状管理至关重要。然而，高达50%的 患者的症状未被发现，症状的电子健康记录（EHR）记录 不完整突破性的研究表明，在癌症护理期间，患者报告的症状（PRO）监测 与改善症状控制、减少急性护理使用和延长生存期相关。然而，一个更接近 对文献的调查发现PRO对癌症结果的影响取决于实施。 PRO实施变化的原因包括与电子健康记录（EHR）的集成有限， 机会不平等，缺乏标准化办法，阻碍了 PRO。我们为HNC开发了纽约大学电子患者访视评估（ePVA）量表，作为有效、可靠的PRO 它已经发展成为一种临床支持工具，用于早期发现不受控制的症状。ePVA提供了 在护理点自动向临床医生提供患者状况的全局图像，从而实现实时干预。 我们在32例接受放射治疗的HNC患者中完成了ePVA的初步随机临床试验 (RT)有或没有化疗，并发现那些分配到ePVA+泌尿系护理组报告显着 HNC症状（p<0.05）和急性护理使用（p<0.001）的严重程度低于分配到家庭护理组的患者。 我们提出这项建议的目的，是要找出能发挥电子专业服务计划成效的推行策略， 改善HNC在现实环境中的结果，并探索将ePVA与EHR架构集成， 可扩展性和平等性。为达致这个目的，我们会进行一项混合方法的第I类研究 在三个国家癌症研究所指定的综合癌症中心， 农村和城市环境（纽约大学、堪萨斯大学癌症中心、福克斯蔡斯癌症中心） 使用RE-AIM框架。对于接受RT伴或不伴化疗的HNC受试者， 具体目标是：1）（定量）确定电子患者访视评估（ePVA）对 在一项两组研究中，HNC症状（主要结局）、疼痛、HRQoL和急性护理使用（次要结局） （常规治疗vs. ePVA+常规治疗）多中心随机临床试验（n=270）; 2）（定性）检查HNC 患者和临床医生对患者、临床医生和组织促进者的看法以及ePVA的障碍 覆盖范围、采用率、有效性和维护; 3）（综合）确定实施策略，优化 ePVA的范围、采用、有效性和维护;探索性目标：探索集成的可用性 ePVA与EHR系统（n=30）。这项研究的长期目标是确定实施和 有效、广泛使用ePVA的技术标准，适用于癌症护理中的所有PRO。