PatientCareAnywhere: Patient Support and Empowerment Across the Care Continuum

 描述(由申请人提供)：全面的生物心理社会筛查，不仅涵盖身体症状和心理社会问题，还包括交通、经济、工作和育儿等实际问题，提供真正的机会，最大限度地为患者及其家人带来医疗和社会支持的好处，同时提高医疗保健组织的运营效率和资源管理，因为识别和有效管理癌症护理的生物心理社会要素。及早发现患者问题对于管理痛苦、预防危机、最大限度地减少系统中断和降低医疗保健成本至关重要。由于加强沟通和更好的护理协调，可能还会增加与患者、家庭和卫生保健工作人员满意度有关的好处。PatientCareAnywhere作为一种以患者为中心的适应性支持性护理系统，其首要目标是在降低医疗成本的同时改善癌症患者的预后。PatientCareAnywhere将成为一种患者赋权解决方案，通过与患者和医疗保健专业人员在整个护理连续体中建立新的合作伙伴关系来提高内部韧性和自我效能：1)地理上(家庭-医院-社区-家庭)和2)医学上(诊断-治疗-生存-死亡)。这种支持将以全面的生物心理社会筛查为基础，适应个人的需要和健康状况，并通过转介、教育、参与社区资源和安全社会交流等形式协调多种来源。该项目是基于光明结果和希望之城(COH)之间的合作伙伴关系。PatientCareAnywhere将源自两个现有的系统，COH的Support Screen和Bright Outcome的MyCaringCircle，这两个系统拥有相同的愿景，并且在方法上是互补的。Support Screen专注于从基于诊所的接触中发起的支持性护理，MyCaringCircle是一个基于家庭/社区的患者门户解决方案。这两个系统结合在一起，可以为患者提供全面的生物心理社会筛查和支持性护理，跨越从家庭到医院的设置，并跨越癌症护理的连续统一体。这是一个快速通道项目。第一阶段的目标是：1)通过焦点小组收集100名利益相关者对预期系统功能、感知的有用性和影响以及潜在采用障碍的意见；2)通过利用Support Screen和MyCaringCircle并通过改编COH的患者教育材料来设计和开发PatientCareAnywhere原型；3)进行两次可用性测试，每组24名受试者，以及一项50名受试者的试点研究。第二阶段的目标是：1)在第一阶段评估反馈的基础上增强和改进第一阶段原型，扩大疾病阶段和治疗方式支持覆盖范围；以及2)对516名患者进行随机对照试验，以确认我们的研究假设，即与常规护理相比，PatientCareAnywhere获得更好的患者结果、更好的自我效能和更具成本效益的医疗服务利用。

 DESCRIPTION (provided by applicant): Comprehensive bio psychosocial screening, which covers not only physical symptoms and psychosocial issues, but also practical concerns such as transportation, finances, work and childcare, offers the true opportunity to maximize the benefits of medical care and social support to patients and their families while enhancing operational efficiency and resource management for healthcare organizations because of the identification and effective management of the bio psychosocial elements of cancer care. The early identification of patient problems is essential to manage distress, prevent crises, minimize system disruption, and reduce the costs of health care. There may be also added benefits related to patient, family and health care staff satisfaction as a result of enhanced communications and better care coordination. The overarching goal of PatientCareAnywhere as a patient-centered adaptive supportive care system is to improve patient outcomes for cancer patients while reducing healthcare costs. PatientCareAnywhere will be a patient empowerment solution to promote internal resilience and self-efficacy by creating new partnerships with patients and health care professionals across the care continuum: 1) geographically (home-hospital-community-home) and 2) medically (diagnosis-treatment-survivorship-death). Such support will be adaptive to individual's needs and health status based on comprehensive bio psychosocial screening and coordinated across multiple sources in the forms of referrals, education, engagement of community resources, and secure social communication. This project is based on the partnership between Bright Outcome and City of Hope (COH). PatientCareAnywhere will be derived from two existing systems, COH's Support Screen and Bright Outcome's MyCaringCircle, which share the same vision and are complementary in their approaches. Support Screen focuses on supportive care initiated from clinic-based encounters and MyCaringCircle is a home/community-based patient portal solution. Together, these two systems can provide comprehensive bio psychosocial screening and supportive care to patients across home to hospital settings and across the continuum of cancer care adaptively. This is a Fast-Track project. Phase I aims are to: 1) Collect input from 100 stakeholders on expected system features, perceived usefulness and impacts, and potential adoption barriers via focus groups; 2) Design and develop the prototype PatientCareAnywhere by leveraging support Screen and MyCaringCircle and by adapting the patient education materials from COH; 3) Conduct two usability tests with 24 subjects each and a pilot study with 50 subjects. Phase II aims are to: 1) Enhance and refine Phase I prototype based on Phase I evaluation feedback and expand disease stage and treatment modality support coverage; and 2) Conduct a randomized controlled trial with 516 patient subjects to confirm our study hypotheses of achieving better patient outcomes, better self-efficacy, and more cost-effective health service utilization with PatientCareAnywhere as compared to usual care.