Scalable TELeheaLth Cancer CARe: The STELLAR Program to Treat Cancer Risk Behaviors

摘要 拟议的可扩展远程保健癌症护理研究中心(STELLA)设在该研究所 医学部(IOM)的愿景是，高质量的癌症护理不仅包括疾病的治疗，还包括促进 患者的长期健康和生活质量。癌症危险行为(例如，吸烟、缺乏运动、 肥胖与治疗反应差、与治疗相关的副作用、复发增加有关 许多癌症的风险、寿命降低、生活质量(QOL)降低和治疗费用增加2-8。 这些危险行为在癌症患者中至少和在健康成年人中一样普遍，但被转介 治疗它们的途径通常不会整合到癌症治疗中。通过整合癌症风险行为 对电子病历和自动转诊的评估，我们计划对健康风险进行远程医疗治疗 行为(一种称为健康促进的临床服务)，癌症提供者和患者在整个过程中都可以获得 西北大学的临床实践网络，以负担得起的方式，提高护理质量，并最大限度地减少 扰乱临床工作流程。这项建议的MPI已经开发出来，并且是远程方面的专家 评估患者症状并为大多数癌症患者提供有效、廉价的远程医疗治疗 普遍而有力的行为风险因素。身体不活动，肥胖，吸烟11我们的初步数据 建议远程医疗，与面对面的癌症护理相比，可能使老年人更容易获得治疗 成年人和少数族裔。利用癌症登月和其他基金，我们共同开发了患者报告 集成到单个电子病历中的评估、症状管理和共享决策工具 (EPIC)连接西北纪念医疗保健公司(NMHC)11家医院的医疗保健系统 传送系统。我们还开发了一个戒烟计划，在整个NMHC提供。作为对.的回应 来自NM癌症质量改进小组的需求，我们现在建议实施、优化、评估和 传播更全面、完全集成、以患者为中心、技术辅助的远程医疗风险 行为治疗计划，积极解决缺乏运动、肥胖和吸烟导致癌症的问题 NMHC系统中的患者。我们计划进行一项务实的试验，以测试其对公平护理机会、卫生保健的影响 结果、护理质量、护理利用率、提供者与患者之间的沟通、患者报告的结果和成本。 明星计划将通过提炼、传播和提高患者的长期健康和生活质量 支持针对多种危险行为的首个针对癌症的远程健康治疗计划被完全整合 变成了高质量的癌症护理。

Abstract The proposed research center for Scalable TELeheaLth Cancer CARe (STELLAR) is grounded in the Institute of Medicine (IOM) vision that quality cancer care includes not only treatment of the disease, but also promotion of the patient’s long-term health and quality of life. Cancer risk behaviors (e.g., smoking, physical inactivity, obesity1) are associated with poor treatment response, treatment-related side effects, heightened recurrence risk, decreased longevity, diminished quality of life (QOL), and increased treatment cost for many cancers2-8. These risk behaviors are at least as prevalent in cancer patients as they are in healthy adults, but referral pathways to treat them are not routinely integrated into cancer care. By integrating cancer risk behavior assessment into the EHR and automating referral, we plan to make telehealth-enabled treatment of health risk behaviors (a clinical service called health promotion) accessible to cancer providers and patients throughout Northwestern’s clinical practice network in a manner that is affordable, improves care quality, and is minimally disruptive to clinical workflow. The MPIs of this proposal have developed, and are experts at, remotely assessing patient symptoms and delivering effective, inexpensive, telehealth treatment of cancer’s most prevalent and potent, behavioral risk factors. physical inactivity9, obesity10, smoking11 Our preliminary data suggest that telehealth, as compared to in-person cancer care, may make treatment more accessible to older adults and minorities. With Cancer Moonshot and other funds, we have collectively developed patient-reported assessment, symptom management, and shared decision-making tools that are integrated into the single EHR (Epic) system that links the Northwestern Memorial HealthCare Corporation’s (NMHC)11-hospital healthcare delivery system. We also developed a smoking cessation program offered throughout NMHC. In response to demand from NM’s Cancer Quality Improvement group, we now propose to implement, optimize, evaluate, and disseminate a more comprehensive, fully integrated, patient-centered, technology-assisted telehealth risk behavior treatment program that proactively addresses physical inactivity, obesity, and tobacco use for cancer patients in the NMHC system. We plan a pragmatic trial to test its impact on equitable care access, health outcomes, care quality, care utilization, provider-patient communication, patient-reported outcomes, and cost. The STELLAR program will foster patients’ long-term health and quality of life by refining, disseminating, and sustaining the first cancer-specific telehealth treatment program for multiple risk behaviors to be fully integrated into quality cancer care.