Improving Thoracic Surgical Care using electronic Patient-Reported Outcomes (ePROs)

项目摘要/摘要 胸部手术后的严重并发症很常见，并导致再次入院和 死亡率。出现并发症的早期症状可能不会在通常的计划中被发现 在病情恶化和恶化之前进行术后护理。术后护理可以远程和远程进行。 通过以电子方式向患者提供调查的自动化系统实时地直接捕获患者- 报告结果，并向提供者发送警报，以获得有关答复(EPRO)。EPRO提高质量 在几个大型临床试验中的寿命、医疗保健利用率和存活率，以及正在出现的证据 肿瘤患者实际应用中的临床效果。EPRO也被证明是 适用于胸部和结直肠手术患者的小型试验中的症状管理。这些数据 提示ePRO有可能改善胸部和其他高风险手术后的护理。然而，在那里 在常规外科护理中没有广泛实施的ePRO系统，尽管来自其他环境的证据表明 支持系统地确定并解决实施中的预期障碍的价值 EPRO的设计。目前在设计用于外科护理的ePRO方面的知识差距包括 最佳的调查/警报功能和工作流程、常规使用的障碍以及临床有效性。 这一职业发展奖的候选人莫迪医生是一名胸科外科医生，他的职业目标是 是改善慢性肺部疾病患者的临床和以患者为中心的结果 做手术。拟议的奖励将建立在她之前的公共卫生硕士的基础上，其中包括生物统计学和 健康服务研究，并将在她实现职业生涯所需的领域提供高级培训 目标。具体地说，在获奖期间，莫迪博士将接受定性数据分析方面的培训，包括 混合方法和实施科学的研究方法。莫迪博士将进行一项前瞻性研究 胸外科手术后使用ePROS的实施和效果结果。为了确保 她的成功，一个由具有互补专业知识的跨学科导师和顾问组成的团队 入选的包括Ethan Basch博士(肿瘤学临床试验，专业研究)，Jennifer Leeman博士 (实施，定性研究)，Antonia Bennett博士(生活质量测量，定性研究)， Andrea Pusic博士(外科临床试验，专业研究)，Angela Smith博士(外科，健康信息 PRO测量技术)和Angela Stover博士(PROS的实施)。到年底的时候 在获奖期内，莫迪博士将拥有必要的初步数据和培训，以成功地执行大型 评估ePRO系统在中国的实施和效果的规模随机对照试验 心胸外科手术患者。在胸外科患者中设计和评估这样的系统首先是 重要的是，它们为越来越多的医学复杂患者提供了一个模型，需要 慢性疾病的侵入性治疗，对于那些EPRO可能会显著改善结果的人。

Project Summary/Abstract Severe complications after thoracic surgery are common and lead to increased readmissions and mortality. The early symptoms of developing complications may not be detected by the usual scheduled postoperative care before they worsen and become severe. Postoperative care can be done remotely and in real-time with automated systems that electronically deliver surveys to patients to directly capture patient- reported outcomes and send alerts to providers for concerning responses (ePROs). ePROs improve quality of life, healthcare utilization, and survival in several large clinical trials as well as have emerging evidence of clinical effectiveness in real-world applications in oncology patients. ePROs also have been shown to be feasible for symptom management in small trials of thoracic and colorectal surgery patients. These data suggest ePROs have the potential to improve care after thoracic and other high-risk surgery. However, there are no widely implemented ePRO systems in routine surgical care, despite evidence from other settings to support the value of systematically identifying and then addressing anticipated barriers to implementation in the ePRO design. Current gaps in knowledge to designing ePROs for use in surgical care include identifying optimal survey/alert features and workflow, barriers to routine use, and clinical effectiveness. The candidate for this career development award, Dr. Mody, is a thoracic surgeon whose career goal is to improve clinical and patient-centered outcomes for patients with chronic lung conditions requiring surgery. The proposed award will build on her prior MPH that included formal training in biostatistics and health services research and will provide advanced training in areas necessary for her to achieve her career goals. Specifically, during the award period Dr. Mody will receive training in qualitative data analysis including mixed methods and implementation science research methods. Dr. Mody will perform a prospective study of implementation and effectiveness outcomes in thoracic surgery clinics using postoperative ePROs. To ensure her success, an interdisciplinary team of mentors and advisors with complementary expertise have been enlisted including Dr. Ethan Basch (clinical trials in oncology, PRO research), Dr. Jennifer Leeman (implementation, qualitative research), Dr. Antonia Bennett (quality of life measurement, qualitative research), Dr. Andrea Pusic (clinical trials in surgery, PRO research), Dr. Angela Smith (surgery, health information technology for PRO measurement), and Dr. Angela Stover (implementation of PROs). By the end of the award period, Dr. Mody will have the necessary preliminary data and training to successfully perform a large scale randomized controlled trial to evaluate the implementation and effectiveness of an ePRO system in cardiothoracic surgery patients. Designing and evaluating such a system in thoracic surgery patients first is important as they serve as a model for the increasing numbers of medically complex patients requiring invasive treatments for chronic conditions and for whom ePROs may substantially improve outcomes.