Feasibility and Effectiveness of Automated Geriatric Co-Management Program on Improving the Perioperative Care of Older Lung Cancer Patients

自动化老年共同管理计划改善老年肺癌患者围手术期护理的可行性和有效性

基本信息

  • 批准号:
    9789152
  • 负责人:
  • 金额:
    $ 26.94万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2018
  • 资助国家:
    美国
  • 起止时间:
    2018-09-30 至 2022-05-31
  • 项目状态:
    已结题

项目摘要

ABSTRACT: The purpose of this project is to improve the perioperative outcomes of older lung cancer patients. Every year, 120,000 patients age 65 or older every year are diagnosed with lung cancer. Surgery offers the highest likelihood of cure to early-stage lung cancer patients. However, older frail cancer patients are at a higher risk for adverse surgical outcomes & slow functional recovery compared to younger and older fit lung cancer patients. One study showed that 5.6% of frail patients died after lung surgery compared to just 1% of fit patients. Frailty can be assessed by Geriatric Assessment (GA). However, GA without proper interventions to manage the identified age-related impairments will not improve outcomes. In the non-oncologic setting, collaboration between surgeons and geriatricians has improved surgical outcomes. In a study of 319 orthopedic patients, in-hospital mortality decreased from 5.8% to 0.6% following such collaboration. As a result, collaboration between surgeons and geriatricians is becoming the standard for improving surgical outcomes of older patients. However, with only 7000 geriatricians practicing in the US, such collaboration between thoracic oncology surgeons and geriatricians may not always be feasible. In an attempt to address this need, in 2015, we developed and implemented an electronic Rapid Fitness Assessment (eRFA), a web- based GA, in our institution. The Memorial Hospital Thoracic Service has implemented the eRFA in their clinics as a point of care. Moving ahead with the need to intervene based on GA, our scalable solution is to provide thoracic surgeons with an Automated Geriatric Comanagement Program. Following completion of the eRFA by the patients, the Program summarizes the identified impairments and provides recommendations that were developed based on published guidelines, and our geriatric expertise. The primary aim of our current study is to test the feasibility & acceptability of this Program. We will deem the Program feasible if surgical teams follow at least 50% of recommendations in at least 70% of patients. The program will be considered acceptable if 80% of surgeons & nurses have high/very high satisfaction with the Program. By performing a randomized controlled trial on 200 lung cancer patients age 65+, we aim to collect preliminary data on the difference between adverse surgical events & postoperative functional recovery of patients in the automated geriatric comanagement program group vs. collaboration between surgeons & geriatricians. Functional recovery will be assessed by patient-reports on Karnofsky performance scale (KPS), basic & instrumental activities of daily living (bADL, iADL), by Timed Up & Go (TUG), & 6Minute Walk test (6MWT), two weeks after hospital discharge. Finally, we will explore the possibility of using wearable devices measuring activity as an alternative way to collect objective data rather than KPS,bADL,iADL, TUG & 6MWT. We will use this data as the foundation for a fully powered multi-institutional R01 study on the effectiveness of automated-Geriatric Comanagement Program on improving surgical outcomes & functional recovery of older lung cancer patients.
摘要:该项目的目的是改善老年肺癌患者的围手术期预后。 病人。每年有12万名65岁或以上的患者被诊断为肺癌。外科手术 为早期肺癌患者提供最高的治愈可能性。然而,年长虚弱的癌症患者 与年轻人和老年人相比,手术结果不良和功能恢复缓慢的风险更高 肺癌患者。一项研究表明,5.6%的虚弱患者在肺部手术后死亡,而这一比例仅为1% 健康的病人。脆弱程度可通过老年评估(GA)进行评估。然而,遗传算法没有适当的 对已确定的与年龄相关的损害进行管理的干预措施不会改善结果。在非肿瘤学领域 在此背景下,外科医生和老年医生之间的合作改善了手术结果。在一项关于319 在整形外科患者中,住院死亡率从5.8%下降到0.6%。作为一名 结果,外科医生和老年医生之间的合作正在成为提高外科手术水平的标准 老年患者的转归。然而,在美国只有7000名老年医生执业,这样的合作 胸部肿瘤外科医生和老年医生之间的合作可能并不总是可行的。在试图解决 在这种需求下,我们在2015年开发并实施了电子快速健身评估(ERFA),一个网络- 以GA为基础,在我们机构。纪念医院胸科已经在他们的诊所实施了eRFA 作为一种关照。随着需要基于GA进行干预,我们的可扩展解决方案将提供 胸外科医生与自动化老年管理程序。在以下情况下完成了环境影响评估 对于患者,该计划总结了已识别的损害并提供了以下建议 根据已公布的指南和我们的老年学专业知识开发的。我们目前研究的主要目的是 以检验该计划的可行性和可接受性。如果外科手术团队跟进,我们将认为该计划是可行的 在至少70%的患者中至少有50%的建议。如果符合以下条件,该计划将被视为可接受 80%的外科医生和护士对该计划的满意度很高/非常高。通过执行随机的 对200例65岁以上肺癌患者进行的对照试验,我们的目的是收集关于这种差异的初步数据 自动化老年患者手术不良事件与术后功能恢复的关系 管理计划小组与外科医生和老年医生之间的协作。功能恢复将是 由患者报告卡诺夫斯基表现量表(KPS)、日常基本和仪器性活动进行评估 生活(Badl,IADL),定时起身(TUG),6分钟步行试验(6MWT),住院两周后 出院。最后,我们将探索使用可穿戴设备测量活动作为替代方案的可能性 收集客观数据的方法,而不是KPS、BADL、IADL、TUG和6MWT。我们将使用此数据作为 全动力多机构R01自动化老年医疗有效性研究的基础 改善老年肺癌患者手术结果和功能恢复的管理方案。

项目成果

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