Onco-primary care networking to support TEAM-based care - the ONE TEAM Study

支持基于 TEAM 的护理的肿瘤初级护理网络 - ONE TEAM 研究

• 批准号: 10759089
• 负责人: Kevin Charles Oeffinger
• 金额: $ 4.96万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-06 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10759089
• 关键词: Acute; Adherence; Adult; Affect; Aftercare; Aging; Attention; Back; Behavior; Behavioral Sciences; Biometry; Breast; Cancer Center; Cancer Patient; Cancer Survivor; Cardiovascular Diseases; Caring; Chronic; Clinic; Clinical; Colorectal; Communication; Communities; Data; Diet; Education; Effectiveness; Electronic Health Record; Emergency department visit; Endometrial; Enrollment; Exercise; Genetic; Goals; Growth; Head and neck structure; Health; Healthcare; Healthcare Systems; Hypertension; Individual; Institute of Medicine (U.S.); Interdisciplinary Study; Internal Medicine; Intervention; Interview; Laboratories; Length of Stay; Letters; Life Style; Malignant Neoplasms; Measurement; Measures; Mediating; Medical; Medical Oncologist; Methods; Newly Diagnosed; Non-Insulin-Dependent Diabetes Mellitus; Non-Small-Cell Lung Carcinoma; North Carolina; Oncologist; Oncology; Outcome; Outpatients; Participant; Patient Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacy facility; Phase; Population; Population Heterogeneity; Population Sciences; Primary Care; Productivity; Prostate; Provider; Randomized; Randomized, Controlled Trials; Recurrent Malignant Neoplasm; Reporting; Research; Research Design; Risk; Seminal; Sequential Multiple Assignment Randomized Trial; Series; Specialist; Survival Rate; Survivors; Therapeutic; Time; Titrations; Touch sensation; Training; Visit; cancer care; cancer recurrence; cancer risk; cancer therapy; cardiovascular disorder risk; care coordination; care costs; care delivery; comorbidity; comparison intervention; cost; effectiveness evaluation; empowerment; experience; financial toxicity; follow-up; group intervention; health care delivery; hypercholesterolemia; improved; medication compliance; member; mortality risk; patient oriented; patient-clinician communication; prevent; primary care patient; primary care provider; primary care team; primary outcome; provider communication; risk stratification; sociodemographics; survivorship; team-based care; theories; treatment as usual; trial design; webinar

PROJECT SUMMARY Since the Institute of Medicine (IOM) released the seminal report, From Cancer Patient to Cancer Survivor: Lost in Transition 13 years ago, there has been substantial progress in understanding the health issues affecting cancer survivors, yet little has changed regarding survivorship care delivery. There remains a disconnect between primary care providers and oncology care teams that has led to persistent problems implementing risk-stratified survivorship care for cancer survivors. With advances in cancer therapy and improved survival rates, the risk of death from cardiovascular disease (CVD) now exceeds that of the cancer for many survivors. While cancer therapy may contribute to this risk, it is generally a compilation of non-modifiable factors (i.e., genetics, aging), as well as modifiable lifestyle behaviors (i.e., diet, exercise) that lead to both the cancer and to cardiovascular disease (CVD). With the lack of primary care provider (PCP) integration in the cancer care team and time constraints and difficulty keeping up with rapidly evolving non-cancer therapeutics for medical oncologists, there is an inferred lower priority for comorbidity management. We will determine the effectiveness of the multi-level iGuide intervention and the up-titrated iGuide2 intervention compared with usual care on the primary outcomes. The theory-driven, self-guided iGuide intervention consists of patient-level components (video vignettes, patient-facing webinars) and PCP-level components (electronic health record [EHR] automated cancer specialist-PCP letter, tele-education series, and automated reminders). The up-titrated iGuide2 intervention consists of tailored patient-level video vignettes and targeted EHR specialist-PCP communication. The primary outcomes of the ONE TEAM SMART-design study are (1) Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of the three CVD comorbidities (hypertension, type 2 diabetes mellitus, hypercholesterolemia) based upon laboratory and clinical measurement; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care). Secondary aims include exploring moderating and mediating factors in each level of the intervention, support of patient-centered outcomes, health care use, measures of provider activation, and costs of care resulting from the multi-level intervention. The overarching goal of this proposed project is to optimize the management and outcomes of individuals with cancer, both during and after treatment, and to develop a ‘low-touch’ multi-level intervention that can be generalized, adapted and scaled in other health care systems. The proposed ONE TEAM study brings together a multi-disciplinary research team with the necessary expertise and experience in survivorship research, population and behavioral science, primary care, oncology, and biostatistics. Results from this intervention will have important implications in the advancement of healthcare delivery for cancer survivors.

项目摘要 医学研究所（IOM）发布了一份开创性的报告，从癌症患者到癌症幸存者： 13年前，在理解健康问题方面取得了实质性进展， 影响癌症幸存者，但在提供幸存者护理方面几乎没有变化。仍然 初级保健提供者和肿瘤护理团队之间的脱节导致了持续的问题 对癌症幸存者实施风险分层生存护理。 随着癌症治疗的进步和生存率的提高，死于心血管疾病的风险 (CVD)现在已经超过了许多幸存者的癌症。虽然癌症治疗可能会导致这种风险，但它是 通常是不可修改因素的汇编（即，遗传学，衰老），以及可改变的生活方式行为 (i.e.,饮食，运动），导致癌症和心血管疾病（CVD）。由于缺乏初级 护理提供者（PCP）在癌症护理团队中的整合以及时间限制和难以跟上 对于医学肿瘤学家来说，快速发展的非癌症疗法， 公司管理 我们将确定多节段iGuide干预和上调iGuide 2的有效性 干预与常规护理的主要结果进行比较。理论驱动、自我指导的iGuide 干预包括患者层面的组件（视频短片，面向患者的网络研讨会）和PCP层面的 组件（电子健康记录[EHR]自动癌症专家-PCP信，远程教育系列， 自动提醒）。向上滴定的iGuide 2干预由定制的患者级视频小插曲组成 和有针对性的EHR专家-PCP通信。 ONE TEAM SMART设计研究的主要结局是（1）医疗保健有效性数据， 三种CVD合并症（高血压，型）管理的信息集（HEDIS）质量指标 2糖尿病、高胆固醇血症）;（2）药物治疗 使用覆盖天数比例（PDC）评估药房续药数据的依从性;以及（3）患者-提供者 以患者为中心的沟通（Patient-Centered Communication）次要目标包括探索 每个干预水平的调节和中介因素，以患者为中心的结果的支持， 卫生保健使用、提供者激活措施以及多层次干预导致的护理成本。 该拟议项目的总体目标是优化个人的管理和成果， 癌症，在治疗期间和治疗后，并制定一个“低接触”的多层次干预，可以 在其他医疗保健系统中推广、调整和扩展。拟议的一个团队研究汇集了 一个多学科的研究团队，在生存研究方面具有必要的专业知识和经验， 人口与行为科学、初级保健、肿瘤学和生物统计学。本次干预的结果将 对促进癌症幸存者的医疗保健提供具有重要意义。