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

总结 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个卫生保健设施提供护理，包括171个医疗中心和1，112个门诊点， 为约900万注册退伍军人提供服务。它也是最大的教育系统之一，70%的 接受过一些VA培训的医生。为了体现其护理病人的三方使命， 在教育和研究方面，弗吉尼亚州资助的研究比美国其他任何医疗保健系统都多。虽然大多数 光荣退伍的退伍军人有资格使用VA进行护理，但不成比例地被那些没有 其他健康保险。因此，退伍军人事务部在一定程度上充当了退伍军人的国家“安全网”卫生系统。为 由于这个原因，以及其他许多原因，健康公平一直是VA医疗保健的重要目标。 VA的肿瘤治疗是多学科的，初级保健，血液学/肿瘤学， 外科肿瘤学、放射肿瘤学和其他。初级保健是基于以病人为中心的医疗之家 因此，初级保健团队通常包括护理，药房，社会工作和心理学。这 统一的国家电子健康记录（EHR）系统和通用的 虚拟医疗平台凭借其对质量改进的持续关注，以患者为中心的护理， 健康公平，VA医疗保健系统将作为创新的远程肿瘤学研究的背景 由该中心提出，远程医疗研究和创新的退伍军人与癌症（繁荣）。 临床实践网络核心将作为THRIVE的临床协调中心。将 负责：1）组织患者招募和识别; 2）作为“技术中心”， 协调与中心项目有关的所有以技术为重点的活动; 3）作为中心的护理人员， 协调中心，以便通过网络协调站点上的所有护理。我们已经有 与VA国家肿瘤计划办公室和VA互联护理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事务计划办公室和个人的联络，加强我们的联系 研究中心。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 信息学，促进社会各阶层癌症患者的公平招募和登记;以及（3）创建 一个学习研究的环境，包括评估和迭代过程的改进。

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.