Feasibility and Effectiveness of Automated Geriatric Co-Management Program on Improving the Perioperative Care of Older Lung Cancer Patients

摘要：本项目的目的是改善老年肺癌的围手术期结局 患者每年有120，000名65岁或以上的患者被诊断患有肺癌。手术 为早期肺癌患者提供了最高的治愈可能性。然而，年老体弱的癌症患者 与年轻人和老年人相比，手术不良结局和功能恢复缓慢的风险更高 肺癌患者。一项研究表明，5.6%的体弱患者在肺部手术后死亡，而只有1%。 健康的病人。虚弱可以通过老年评估（GA）进行评估。然而，GA没有适当的 对已查明的与年龄有关的缺陷进行管理的干预措施不会改善结果。在非肿瘤 在这种情况下，外科医生和老年病学家之间的合作改善了手术结果。在319项研究中， 骨科患者，住院死亡率从5.8%下降到0.6%后，这种合作。作为 因此，外科医生和老年病学家之间的合作正在成为改善外科手术的标准。 老年患者的结局。然而，由于美国只有7000名老年病医生， 胸部肿瘤外科医生和老年病学家之间的沟通可能并不总是可行的。为了解决 为了满足这一需求，我们在2015年开发并实施了电子快速健身评估（eRFA），这是一个网络， 基于GA，在我们的机构。纪念医院胸科服务已在其诊所实施了eRFA 作为一个护理点。随着基于GA的干预需求的发展，我们的可扩展解决方案将提供 胸外科医生与自动老年人护理程序。eRFA完成后， 该计划总结了已识别的障碍，并提供了建议， 根据已发布的指南和我们的老年医学专业知识开发。我们目前研究的主要目的是 测试本项目的可行性和可接受性。如果手术团队跟进，我们将认为该计划可行 在至少70%的患者中至少50%的建议。该计划将被认为是可接受的，如果 80%的外科医生和护士对该计划表示高度/非常高的满意度。通过执行随机 我们对200名65岁以上的肺癌患者进行了一项对照试验，目的是收集有关差异的初步数据。 老年自动化手术中不良手术事件与患者术后功能恢复之间的关系 外科医生和老年病学家之间的合作。功能恢复将是 通过Karnofsky行为量表（KPS）、日常基本和工具活动的患者报告进行评估 生活（bADL，iADL），通过定时起身和行走（TUG）和6分钟步行试验（6 MWT），住院后2周 放电最后，我们将探讨使用可穿戴设备测量活动作为替代方案的可能性 收集客观数据的方法，而不是KPS，bADL，iADL，TUG和6 MWT。我们将使用这些数据作为 一个完全动力的多机构R 01研究的基础上，自动化老年医学的有效性 改善老年肺癌患者手术效果和功能恢复的护理计划。

ABSTRACT: The purpose of this project is to improve the perioperative outcomes of older lung cancer patients. Every year, 120,000 patients age 65 or older every year are diagnosed with lung cancer. Surgery offers the highest likelihood of cure to early-stage lung cancer patients. However, older frail cancer patients are at a higher risk for adverse surgical outcomes & slow functional recovery compared to younger and older fit lung cancer patients. One study showed that 5.6% of frail patients died after lung surgery compared to just 1% of fit patients. Frailty can be assessed by Geriatric Assessment (GA). However, GA without proper interventions to manage the identified age-related impairments will not improve outcomes. In the non-oncologic setting, collaboration between surgeons and geriatricians has improved surgical outcomes. In a study of 319 orthopedic patients, in-hospital mortality decreased from 5.8% to 0.6% following such collaboration. As a result, collaboration between surgeons and geriatricians is becoming the standard for improving surgical outcomes of older patients. However, with only 7000 geriatricians practicing in the US, such collaboration between thoracic oncology surgeons and geriatricians may not always be feasible. In an attempt to address this need, in 2015, we developed and implemented an electronic Rapid Fitness Assessment (eRFA), a web- based GA, in our institution. The Memorial Hospital Thoracic Service has implemented the eRFA in their clinics as a point of care. Moving ahead with the need to intervene based on GA, our scalable solution is to provide thoracic surgeons with an Automated Geriatric Comanagement Program. Following completion of the eRFA by the patients, the Program summarizes the identified impairments and provides recommendations that were developed based on published guidelines, and our geriatric expertise. The primary aim of our current study is to test the feasibility & acceptability of this Program. We will deem the Program feasible if surgical teams follow at least 50% of recommendations in at least 70% of patients. The program will be considered acceptable if 80% of surgeons & nurses have high/very high satisfaction with the Program. By performing a randomized controlled trial on 200 lung cancer patients age 65+, we aim to collect preliminary data on the difference between adverse surgical events & postoperative functional recovery of patients in the automated geriatric comanagement program group vs. collaboration between surgeons & geriatricians. Functional recovery will be assessed by patient-reports on Karnofsky performance scale (KPS), basic & instrumental activities of daily living (bADL, iADL), by Timed Up & Go (TUG), & 6Minute Walk test (6MWT), two weeks after hospital discharge. Finally, we will explore the possibility of using wearable devices measuring activity as an alternative way to collect objective data rather than KPS,bADL,iADL, TUG & 6MWT. We will use this data as the foundation for a fully powered multi-institutional R01 study on the effectiveness of automated-Geriatric Comanagement Program on improving surgical outcomes & functional recovery of older lung cancer patients.