Research and Methods Core - Telehealth Research and Innovation for Veterans with Cancer (THRIVE)

退伍军人事务健康管理局（VA）是美国最大的综合医疗保健系统， 每年有近5万名新诊断出癌症的退伍军人。为所有退伍军人提供公平，高质量的护理是一个 退伍军人医疗使命的宗旨我们假设有三个特殊的因素-种族，贫困和乡村性- 在决定获得医疗保健，特别是远程医疗方面至关重要;我们将这三个因素称为社会 远程保健的决定因素。大约25%的退伍军人生活在农村地区， 当地的VA癌症护理设施。不幸的是，这些社区往往缺乏专门的 以社区为基础的癌症护理服务，以及，使远程保健的一个必要的选择，以减少地理， 经济和种族的障碍，质量，及时的癌症护理。然而，人们对远程保健服务如何提供知之甚少， 癌症退伍军人影响公平提供优质护理，临床结果和护理经验。 作为一个国家综合卫生保健系统，重点是癌症护理的质量和公平性，VA提供了一个 杰出的国家实验室，研究远程保健的使用如何影响保健的获得、质量和公平性。我们 将能够研究针对SDTH的干预措施如何影响远程医疗的使用，以及远程医疗的使用如何 影响质量和公平。我们会广泛宣传这些资料，以协助其他医护系统 了解如何最好地将远程保健纳入癌症护理的连续性。使用的原则 实施科学，远程医疗研究和癌症退伍军人创新（THRIVE）将利用 健康差异研究框架（HDRF），以推进健康公平科学：建立一个新的模式 癌症护理提供解决SDTH和履行承诺，获得优良的癌症护理， 不管是什么形式的沟通。研究和方法核心主要侧重于健康 公平，特别是了解特殊和性别的特殊需要如何影响获得护理和护理质量。 我们的多学科团队将通过专注于肺、结直肠、前列腺和乳腺来实现THRIVE的愿景 癌症和实现五个具体目标：（1）评估利益相关者的背景因素的观点 在多个层面上影响癌症远程医疗的实施和维持;（2）衡量 整个VA癌症护理的个人和远程医疗通信格式;（3）评估如何使用 远程保健用于癌症护理，控制远程保健的社会决定因素-特别是种族/族裔、贫穷 和农村-与癌症护理质量相关;（4）监督选择，发展，实施 在保健公平、执行和评价的交叉点进行10项快速周期试点研究（每年2项） 科学和远程医疗癌症护理;以及（5）制定扩大有效干预措施的可负担性， 从试点研究中发现。

The Veterans Affairs Health Administration (VA) is the largest integrated health care system in the US, caring for nearly 50,000 veterans with newly diagnosed cancer annually. Equitable, quality care for all veterans is a tenet of the VA healthcare mission. We hypothesize that three particular factors – race, poverty and rurality – are critical in determining access to healthcare, especially telehealth; we refer to these 3 factors as the social determinants of telehealth (SDTH). Approximately 25% of veterans live in rural areas where there may not be adequate local VA cancer care facilities. Unfortunately, these same communities often lack specialized community-based cancer care services as well, making telehealth a necessary option to reduce geographic, economic and racial barriers to quality, timely cancer care. However, little is known about how telehealth delivery for veterans with cancer impacts equitable delivery of quality care, clinical outcomes and experiences of care. As a national integrated health care system focused on quality and equity of cancer care, VA provides an outstanding national laboratory to examine how use of telehealth affects access, quality and equity of care. We will be able to examine how interventions targeting SDTH affect the use of telehealth and how use of telehealth affects quality and equity. We will disseminate this information broadly to help other health care systems understand how best to integrate telehealth into the continuum of cancer care. Using principles of implementation science, Telehealth Research and Innovation for Veterans with Cancer (THRIVE) will leverage Health Disparities Research Framework (HDRF) to advance the science of health equity: building a new model of cancer care delivery addressing SDTH and fulfilling the promise of access to excellent cancer care for veterans regardless of communication format. The Research and Methods Core primarily focuses on health equity, particularly understanding how SDTH impact access to and quality of care. Our multidisciplinary team will achieve THRIVE’s vision by focusing on lung, colorectal, prostate and breast cancers and accomplishing five specific aims: (1) Assess stakeholders’ perspectives of contextual factors impacting cancer telehealth implementation and sustainment at multiple levels; (2) Measure the use of in- person and telehealth communication formats for cancer care throughout VA; (3) Evaluate how the use of telehealth for cancer care, controlling for social determinants of telehealth – specifically race/ethnicity, poverty, and rurality – are associated with cancer care quality; (4) Oversee the selection, development, implementation and evaluation of 10 rapid-cycle pilot studies (2/year) at the intersection of health equity, implementation science and telehealth cancer care; and (5) Frame the affordability of scaling up effective interventions that are identified from the pilot studies.