Care Coordination for Complex Cancer Survivors in an Integrated Safety-Net System

项目摘要/摘要 新冠肺炎疫情对癌症幸存者构成了一个新的重大健康威胁。癌症幸存者 通常因癌症治疗而免疫受损，因此感染COVID的风险可能更高- 19除与癌症有关的不良后果外。COVID患者的早期发现表明 有癌症病史的人发生严重事件的风险更高，这些事件导致入院 重症监护病房、呼吸机支持或过早死亡。新冠肺炎也不成比例地影响 弱势、服务不足和少数民族人口；其中许多人在安全网中接受医疗保健 像Parkland这样的卫生系统。那些非裔美国人和拉丁裔或没有保险的人也是 更有可能患有糖尿病、心脏病、哮喘、严重肥胖、 肝病。除了感染新冠肺炎的风险增加外，癌症患者可能还会经历 因新冠肺炎关闭和在家工作而中断和改变他们的临床护理常规 订单；幸存者可能会在癌症治疗和后续护理方面遇到延误。因此，种族/少数民族 得不到充分服务的癌症幸存者也同时患有慢性病，这是一场“完美风暴”。 对健康结果产生重大影响的风险因素以及日益扩大的健康差距。 在这份补充材料中，我们将研究新冠肺炎对弱势癌症幸存者护理的影响 多种慢性病进一步加剧了高临床风险，这些慢性病主要是种族/民族 少数群体，没有保险，由安全网卫生系统提供服务。我们的具体目标是： 目标1：评估新冠肺炎对癌症幸存者整体健康和福祉的影响。使用 混合方法(患者调查和半结构化访谈)，我们将评估新冠肺炎 对患者的身体、情绪和精神健康、经济影响和应对的影响。 目标2：评估新冠肺炎对癌症幸存者获得癌症和非癌症治疗的影响 医疗保健利用率。我们将记录大流行如何影响癌症护理和其他服务的提供 在这个集成的安全网系统中提供医疗服务。我们将检查是否有治疗延误 与癌症或其他合并症有关，在这段时间内获得护理的挑战，以及护理质量 送来了。此外，我们还将记录和量化我们队列中遇到的新冠肺炎的性质 对复杂的癌症幸存者，使用电子健康记录(EHR)数据提取和分析。 这些目标直接利用来自母公司R01的现有研究方法，添加新的协变量和 患者报告的特定于新冠肺炎体验的数据。鉴于新冠肺炎改变了人们的关注点 我们的研究结果将指导利益相关者 在制定新的替代护理战略以减轻对弱势群体的影响方面， 复杂的癌症幸存者。

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic presents a new and significant health threat for cancer survivors. Cancer survivors are often immuno-compromised from cancer treatment and thus may have higher risks of contracting COVID- 19 in addition to adverse outcomes related to cancer. Early findings among COVID patients show that individuals with a history of cancer have a higher risk of severe events that resulted in admittance to the intensive care unit, ventilation support, or premature death. COVID-19 also disproportionately affects vulnerable, underserved, and ethnic minority populations; many of these receive their health care at safety-net health systems such as Parkland. Those who are African American and Latino or who are uninsured are also more likely to have underlying medical conditions such as diabetes, heart conditions, asthma, severe obesity, liver disease. In addition to increased risk of COVID-19 infection, cancer patients may also be experiencing disruptions and changes to their clinical care routines due to COVID-19 shutdown and work-from-home orders; survivors may experience delays in cancer treatment and follow-up care. Thus, racial/ethnic minority and underserved cancer survivors who also have co-occurring chronic conditions represent the "perfect storm" of risk factors for significant impacts on health outcomes as well as increasing health disparities. With this supplement, we will examine the impact of COVID-19 on care for vulnerable cancer survivors with high clinical risk further exacerbated by multiple chronic conditions, who are predominantly racial/ethnic minorities, uninsured, and served by a safety-net health system. Our specific aims are: Aim 1: Assess the impact of COVID-19 on the overall health and wellbeing of cancer survivors. Using a mixed-methods approach (patient surveys and semi-structured interviews), we will assess the COVID-19 effect on patients' physical, emotional, and mental health, financial impact, and coping. Aim 2: Assess the impact of COVID-19 on cancer survivors' access to cancer and non-cancer treatment and healthcare utilization. We will capture how the pandemic impacted the delivery of cancer care and other healthcare services in this integrated safety-net system. We will examine whether there were treatment delays related to cancer or other co-morbidities, challenges accessing care during this time, and the quality of care delivered. Additionally, we will document and quantify the nature of COVID-19 encounters among our cohort of complex cancer survivors, using electronic health record (EHR) data extraction and analysis. These aims directly leverage existing research methods from the parent R01, adding new covariates and patient-reported data specific to the COVID-19 experience. Given that COVID-19 has changed the care delivery process and there is an expectation of other cycles of the disease, our findings will guide stakeholders in the development of new and alternative care strategies that may mitigate impact among vulnerable, complex cancer survivors.