Perioperative Telemonitoring to Optimize Cancer Care and Outcomes

项目摘要 本提案的总体目的是对远程围手术期患者进行一项初步随机试验， 远程监护干预，以改善以患者为中心的结局、手术结局和医疗保健资源 用于计划接受主要腹部胃肠道癌症的英语和西班牙语患者 手术这项研究是至关重要的，因为在癌症手术后，患者的血糖会突然下降， 功能能力，症状增加和生活质量的整体急剧下降，大多数 术后护理和恢复在家里进行。在家里，身体功能可能会下降之前， 手术团队被告知，导致多达三分之一的患者因并发症而出现症状， 可能需要重新入院围手术期症状的远程监测，包括生命体征、体重、 采取的措施和患者报告的结局允许在围手术期进行干预， 减轻并发症和再入院的严重程度。干预是围手术期测量 以护理分诊作为干预措施，以拦截并发症并改善 患者报告结局。我们将使用1：1随机化对干预措施进行试点测试，以实现以下目标 具体目标：具体目标1：评估远程围手术期 远程监护干预，通过a）同意参与; B）完成 >70%的远程监测;以及c）通过结构化离职面谈报告对干预措施的满意度; 具体目标2：确定远程围手术期远程监护干预对 手术结局、医疗保健利用、PRO和功能恢复。这是一项创新，因为 我们是最早也是少数几个研究将以患者为中心的结果转化为可操作的方法的机构之一。 除了使用现有的数字化，还使用客观和主观措施进行术后癌症护理 健康基础设施（Aetonix ™）利用“真实的世界”平台扩展到外科肿瘤学。的 一个跨学科的团队，包括外科肿瘤学（Melstrom）和护理科学（Sun）的专业知识， 非常适合进行这项研究。该提案意义重大，具有高度的科学严谨性和成果 这对癌症患者、临床医生、医疗保健系统和患者的围手术期护理至关重要。 美国国家癌症研究所.这项研究将解决围手术期如何 客观和主观数据的远程监测将改善围手术期癌症的结局和转移 医院外的护理。我们的长期目标是进行一项多中心的III期试验， 干预以建立有效性。

PROJECT SUMMARY The overall purpose of this proposal is to conduct a pilot randomized trial of a remote perioperative telemonitoring intervention to improve patient-centered outcomes, surgical outcomes and healthcare resource use in English and Spanish-speaking patients scheduled to undergo major abdominal gastrointestinal cancer surgery. This research is critical because after cancer surgery, patients experience abrupt declines in functional capacity, increase in symptoms and an overall dramatic decline in quality of life with the majority of postoperative care and recovery taking place at home. While at home, physical function can decline prior to the surgical team being notified leading up to one third of patients becoming symptomatic from a complication that may require readmission. Telemonitoring of symptoms in the perioperative period including vital signs, weight, steps taken and patient reported outcomes allows for an opportunity to intervene in the perioperative period to mitigate severity of complications and readmissions. The intervention is perioperative measurement of parameters in both groups with a nursing triage as the intervention to intercept complications and to improve patient reported outcomes. We will pilot test the intervention using a 1:1 randomization to pursue the following specific aims: Specific Aim 1: Assess the feasibility, retention, and acceptability of the remote perioperative telemonitoring intervention as measured by the percentage of patients who a) agree to participate; b) complete >70% of the telemonitoring; and c) report satisfaction with the intervention through structured exit interviews; Specific Aim 2: Determine the preliminary efficacy of the remote perioperative telemonitoring intervention on surgical outcomes, healthcare utilization, PROs, and functional recovery. This proposal is innovative because we are among the first and few to study methods of transforming patient-centered outcomes into actionable postoperative cancer care using objective and subjective measures in addition to using an existing digital health infrastructure (AetonixTM) leveraging a “real world” platform for expansion into surgical oncology. The interdisciplinary team which includes expertise in surgical oncology (Melstrom) and nursing science (Sun) is uniquely suited to conduct this research. The proposal is significant, with high scientific rigor and outcomes that are of critical importance in perioperative care to cancer patients, clinicians, healthcare systems and the National Cancer Institute. This research will address a critical gap in knowledge of how perioperative telemonitoring of objective and subjective data will improve outcomes and transitions of perioperative cancer care outside of the hospital setting. Our long-term objective is to conduct a multi-site, Phase III trial of the intervention to establish effectiveness.