Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

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The rapid uptake of telehealth since the coronavirus pandemic has highlighted not only the potential for telehealth to improve access and quality of care for some but also how telehealth can exacerbate the “digital divide,” increasing disparities in care and highlighting the need to focus on health equity. Social, economic, environmental, and structural factors collectively known as social determinants of health (SDH) – account for 30-50% of the variance in health outcomes, far more than the 10-20% ascribed to health care. In order to achieve health equity, it is crucial to target these SDH. We will particularly focus on race/ethnicity, poverty and rurality and how they affect use of telehealth, which we refer to as social determinants of telehealth (SDTH). The Veterans Health Administration (VA) is the largest integrated health care system in the US, providing care to 9 million patients across 171 medical centers and 1,112 outpatient sites. VA provides a unique opportunity to examine how SDTH affect use of telehealth for cancer across a health care system with equal access and without focus on reimbursement. Therefore, the entire VA system will serve as our clinical practice network for this Center. All three THRIVE PI’s are experts in implementation science and will use the NIMHD Health Disparities Research Framework and the Consolidated Framework for Implementation Research to guide our understanding of telehealth care delivery for patients with cancer and to explore and understand disparities. We propose a Center called Telehealth Research and Innovation for Veterans with Cancer (THRIVE), whose overarching aim is two-fold: 1) to understand how SDTH impact the delivery of telehealth for cancer and 2) to develop methods to address SDTH and thereby improve access and quality of cancer care for all patients. THRIVE will focus on four highly important and prevalent cancers within VA: lung, colon, prostate, and breast. Our findings will be extremely valuable in understanding how telehealth implementation affects the quality of cancer care for the entire population and how VA and other US health systems can leverage telehealth to improve cancer outcomes and health equity. Our Specific Aims for this Center are: (1) efficiently manage all components of THRIVE, including coordination, communication, fiscal management, recruitment and dissemination (Administrative Core); (2) Identify the impact of SDTH on disparities in telehealth use for cancer care and on overall quality of care and to develop and test implementation strategies to mitigate disparities (Research and Methods Core); (3) Create a high functioning learning network to facilitate research on telehealth for cancer (Clinical Practice Network); (4) conduct a trial assessing the impact of a comprehensive, multilevel virtual oncology program on promoting engagement with telehealth and reducing SDTH-related care disparities (Pragmatic Trial); and (5) Train the next generation of oncology researchers in virtual care and health equity.