Clinical Practice Network - Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

摘要 退伍军人健康管理局(VA)是美国最大的综合医疗保健系统， 在1,293个保健设施提供护理，包括171个医疗中心和1,112个门诊点 为大约900万注册退伍军人提供服务。它也是最大的教育系统之一，有70%的 接受过退伍军人管理局培训的医生。体现了其患者护理的三方使命， 在教育和研究方面，退伍军人管理局也比任何其他美国医疗保健系统资助更多的研究。虽然大多数人 光荣退役的退伍军人有资格使用退伍军人管理局进行护理，而那些没有使用退伍军人退伍军人的人使用退伍军人退伍军人的比例更高 其他医疗保险。因此，退伍军人管理局在一定程度上充当了退伍军人的国家“安全网”卫生系统。为 这一原因，以及其他许多原因，健康公平一直是退伍军人管理局医疗保健的重要目标。 退伍军人事务部的肿瘤学护理是多学科的，初级保健、血液学/肿瘤学、 外科肿瘤学、放射肿瘤学和其他。以病人为中心的医疗之家是初级保健的基础 因此，初级保健团队通常包括护理、药学、社会工作和心理学。这 统一的国家电子健康记录(EHR)系统和共同的 为退伍军人事务部所有虚拟护理提供平台。持续关注质量改进、以患者为中心的护理和 健康公平，退伍军人医疗保健系统将作为创新的远程肿瘤学研究的环境 由该中心提出，为患有癌症的退伍军人进行远程健康研究和创新(Thrive)。 临床实践网络核心将作为Thrive的临床协调中心。会是 负责：1)组织患者招募和鉴定；2)担任技术中心 协调与中心项目相关的所有以技术为重点的活动；以及3)提供关怀 协调中心，以便通过网络协调跨站点的所有护理。我们已经有了 与退伍军人事务部国家肿瘤学项目办公室和退伍军人事务部互联医疗办公室建立了长期的合作关系， 分别监督所有肿瘤护理和所有虚拟护理。临床实践网络核心将进一步 通过与国家退伍军人管理局和个人的联系，加强我们的联系 学习网站。我们的具体目标是：(1)创建一个虚拟的、分散的临床实践网络；(2)利用 为社会各阶层的癌症患者公平招募和登记提供信息学；和(3)创造 结合评估和迭代过程改进的学习研究环境。

SUMMARY The Veterans Health Administration (VA) is the largest integrated health care system in the United States, providing care at 1,293 health care facilities, including 171 medical centers and 1,112 outpatient sites and serving approximately 9 million enrolled Veterans. It is also one of the largest educational systems, with 70% of physicians having received some of their training in VA. Reflecting its tripartite mission of patient care, education and research, VA also funds more research than any other US health care system. While most honorably discharged veterans are eligible to use VA for care, it is disproportionately used by those without other health insurance. As a result, VA acts in part as a national “safety net” health system for veterans. For this reason, and many others, health equity has always been an important goal for VA healthcare. Oncology care in VA is multidisciplinary, with care coordinated between primary care, hematology/ oncology, surgical oncology, radiation oncology and others. Primary care is based on the patient-centered medical home model, so the primary care team typically includes nursing, pharmacy, social work and psychology. This multidisciplinary care is facilitated by a uniform national electronic health record (EHR) system and a common platform for all virtual care in VA. With its continual focus on quality improvement, patient-centered care and health equity, VA health care system will serve as the setting for the innovative tele-oncology research proposed by this center, Telehealth Research and Innovation for Veterans with Cancer (THRIVE). The Clinical Practice Network Core will act as the Clinical Coordinating Center for THRIVE. It will be responsible for: 1) organizing patient recruitment and identification; 2) serve as the “tech center” for coordinating all technology-focused activities related to the center projects; and 3) serve as the care coordination center such that all care across the sites are coordinated via the network. We already have longstanding relationships with VA National Oncology Program Office and VA Office of Connected Care, which respectively oversee all oncologic care and all virtual care. The Clinical Practice Network Core will further strengthen our connections by serving as liaison with both national VA program offices and with individual study sites. Our specific aims are to: (1) Create a virtual, decentralized clinical practice network; (2) Leverage informatics for the equitable recruitment and enrollment of cancer patients across social strata; and (3) Create a learning research environment that incorporates assessments and iterative process improvement.