Pragmatic Trial - Telehealth Research and Innovation for Veterans with Cancer (THRIVE).

四种癌症--肺癌、结肠直肠癌、前列腺癌和乳腺癌--占男性所有癌症死亡人数的近一半 和美国的女性。远程医疗（SDTH）的社会决定因素，例如种族/民族、贫困和 农村，单独和在加和或协同组合发挥重要作用， 癌症护理的结果，往往占观察到的癌症护理的差距。退伍军人健康 管理（VA）是美国最大的癌症护理综合提供商， 为数百万退伍军人提供癌症治疗。然而，即使在弗吉尼亚州，经常赞扬其平等获得护理模式， 癌症护理方面的差距依然存在。然而，虽然VA为SDTH驱动的医疗保健的风险人群提供服务， 它还利用了一个综合的国家单一支付系统的优势，如照顾 协调和远程保健，以改善保健公平性。 Telehelath在肿瘤学中的广泛使用为扩大访问和 改善护理。然而，在某些情况下，对远程保健的依赖可能会扩大“数字鸿沟”， 在将远程保健纳入医疗保健的最佳方式方面存在着重大的知识差距。 肿瘤学实践贯穿整个护理过程。我们的首要目标是提高教育质量和公平性， 通过利用远程医疗治疗退伍军人的经验教训， 癌症在VA的综合医疗保健系统。 实用试验的目的是测试现有的，正在进行的临床服务，VA的有效性 国家远程肿瘤学计划（NTO）是一个多层次的远程医疗人口健康管理计划。我们 提出了一个阶梯式楔形，集群随机，混合有效性的实施研究NTO之间 退伍军人被诊断患有前列腺癌，肺癌，结肠癌和乳腺癌。使用NIMHD健康差异 研究框架，我们将采用混合方法来探索NTO之间的SDTH关联 以及1）服务提供结果，2）分级癌症结果，以及3）实施结果。 具体而言，语用试验的目的是：（1）评估综合多层次虚拟的效果 肿瘤学计划，以促进利益相关者（患者，提供者，管理者）癌症的远程医疗参与 整个SDTH的护理经验;（2）评估全面的多层次虚拟肿瘤学项目的效果 在SDTH期间诊断患有肺癌，结直肠癌，前列腺癌和乳腺癌的退伍军人的癌症护理质量; 和（3）确定一个全面的多级远程肿瘤学计划的影响和成本。 我们提出的混合有效性实施试验，以评估一个全面的虚拟肿瘤学计划 促进远程保健参与和保健公平具有很高的可扩展性和公共卫生影响潜力 无论是内部还是外部。

Four cancers – lung, colorectal, prostate and breast – account for nearly half of all cancer deaths among men and women in the United States. Social determinants of telehealth (SDTH), such as race/ethnicity, poverty and rurality, individually and in additive or synergistic combinations play an important role in access to and outcomes from cancer care, often accounting for the observed cancer care disparities. Veterans Health Administration (VA) is the largest integrated provider of cancer care in the US and provides state of the art cancer care to millions of veterans. Yet even within VA, routinely praised for its equal access to care model, disparities in cancer care persist. However, while VA serves a population at risk for SDTH driven healthcare disparities, it also leverages the advantages of an integrated national single-payer system, such as care coordination and telehealth, to improve health equity. Widespread use of telehelath in oncology creates both challenges and opportunities to expand access and improve care. In some cases, however, reliance on telehealth may widen the “digital divide” for those with limited ability to access it. A major knowledge gap exists regarding the optimal way to integrate telehealth into oncology practice across the care continuum. Our overarching aim is to improve the quality and equity of cancer care across the United States by leveraging lessons learned applying telehealth treating veterans with cancer in VA’s integrated health care system. The objective of the pragmatic trial to test the effectiveness of an existing, ongoing clinical service, the VA National TeleOncology program (NTO), a multilevel telehealth population health management program. We propose a stepped wedge, cluster randomized, hybrid effectiveness-implementation study of NTO among veterans diagnosed with prostate, lung, colon and breast cancers in VA. Using the NIMHD Health Disparities Research Framework, we will employ mixed methods to explore the association across SDTH between NTO and 1) service delivery outcomes, 2) hierarchical cancer outcomes, and 3) implementation outcomes. Specifically, the aims of the pragmatic trial are to: (1) Evaluate the effect of a comprehensive multilevel virtual oncology program to promote telehealth engagement on stakeholder (patient, provider, administrator) cancer care experience across SDTH; (2) Evaluate the effect of a comprehensive, multilevel virtual oncology program on quality of cancer care in veterans diagnosed with lung, colorectal, prostate and breast cancer across SDTH; and (3) Determine the impact and cost of a comprehensive multilevel teleoncology program. Our proposed hybrid effectiveness implementation trial to evaluate a comprehensive virtual oncology program to promote telehealth engagement and health equity has high potential for scalability and public health impact both within and outside of VA.