Pragmatic Trial - Telehealth Research and Innovation for Veterans with Cancer (THRIVE).

四种癌症--肺癌、结直肠癌、前列腺癌和乳腺癌--占男性癌症死亡人数的近一半。 以及美国的女性。远程保健(SDTH)的社会决定因素，如种族/族裔、贫困和 乡村，单独和在相加或协同的组合中，在获得和 癌症护理的结果，通常是所观察到的癌症护理差异的原因。退伍军人健康 美国癌症管理局(VA)是美国最大的癌症综合护理提供商，提供最先进的 数百万退伍军人的癌症护理。然而，即使在退伍军人管理局内部，也经常因其平等获得医疗服务的模式而受到赞扬， 癌症护理方面的差距依然存在。然而，虽然退伍军人管理局为SDTH驱动的医疗保健的风险人群提供服务 除差别外，它还利用综合国家单一付款人制度的优势，如护理 协调和远程保健，以改善卫生公平。 在肿瘤学中广泛使用远程医疗既创造了挑战，也创造了机遇，以扩大获取和 改善护理。然而，在某些情况下，对远程医疗的依赖可能会扩大那些患有远程医疗的人的“数字鸿沟” 访问它的能力有限。关于将远程医疗整合到 整个护理过程中的肿瘤学实践。我们的首要目标是提高质量和公平 通过应用远程医疗治疗退伍军人所学到的经验教训，在全美范围内进行癌症护理 退伍军人事务部综合医疗保健系统中的癌症。 这项务实试验的目标是测试现有的、正在进行的临床服务--退伍军人管理局的有效性 国家远程肿瘤学计划(NTO)，一个多层次的远程健康人口健康管理计划。我们 提出了一种阶梯式、集群随机化、混合有效性的NTO实施研究 退伍军人被诊断患有前列腺癌、肺癌、结肠癌和乳腺癌。使用NIMHD健康差异 研究框架，我们将使用混合方法来探索跨SDTH的NTO之间的关联 和1)服务交付结果，2)癌症分级结果，以及3)实施结果。 具体地说，语用试验的目的是：(1)评价综合多水平虚拟 肿瘤学计划，促进远程医疗参与利益相关者(患者、提供者、管理人员)癌症 跨SDTH的护理体验；(2)评估全面、多层次虚拟肿瘤学计划的效果 关于SDTH中诊断为肺癌、结直肠癌、前列腺癌和乳腺癌的退伍军人的癌症护理质量； 以及(3)确定综合多层次远程肿瘤学计划的影响和成本。 我们建议的混合有效性实施试验以评估全面的虚拟肿瘤学计划 促进远程保健参与和卫生公平具有很高的可扩展性和公共卫生影响潜力 在退伍军人事务部内外都是如此。

Four cancers – lung, colorectal, prostate and breast – account for nearly half of all cancer deaths among men and women in the United States. Social determinants of telehealth (SDTH), such as race/ethnicity, poverty and rurality, individually and in additive or synergistic combinations play an important role in access to and outcomes from cancer care, often accounting for the observed cancer care disparities. Veterans Health Administration (VA) is the largest integrated provider of cancer care in the US and provides state of the art cancer care to millions of veterans. Yet even within VA, routinely praised for its equal access to care model, disparities in cancer care persist. However, while VA serves a population at risk for SDTH driven healthcare disparities, it also leverages the advantages of an integrated national single-payer system, such as care coordination and telehealth, to improve health equity. Widespread use of telehelath in oncology creates both challenges and opportunities to expand access and improve care. In some cases, however, reliance on telehealth may widen the “digital divide” for those with limited ability to access it. A major knowledge gap exists regarding the optimal way to integrate telehealth into oncology practice across the care continuum. Our overarching aim is to improve the quality and equity of cancer care across the United States by leveraging lessons learned applying telehealth treating veterans with cancer in VA’s integrated health care system. The objective of the pragmatic trial to test the effectiveness of an existing, ongoing clinical service, the VA National TeleOncology program (NTO), a multilevel telehealth population health management program. We propose a stepped wedge, cluster randomized, hybrid effectiveness-implementation study of NTO among veterans diagnosed with prostate, lung, colon and breast cancers in VA. Using the NIMHD Health Disparities Research Framework, we will employ mixed methods to explore the association across SDTH between NTO and 1) service delivery outcomes, 2) hierarchical cancer outcomes, and 3) implementation outcomes. Specifically, the aims of the pragmatic trial are to: (1) Evaluate the effect of a comprehensive multilevel virtual oncology program to promote telehealth engagement on stakeholder (patient, provider, administrator) cancer care experience across SDTH; (2) Evaluate the effect of a comprehensive, multilevel virtual oncology program on quality of cancer care in veterans diagnosed with lung, colorectal, prostate and breast cancer across SDTH; and (3) Determine the impact and cost of a comprehensive multilevel teleoncology program. Our proposed hybrid effectiveness implementation trial to evaluate a comprehensive virtual oncology program to promote telehealth engagement and health equity has high potential for scalability and public health impact both within and outside of VA.