Breast Cancer Diagnosis, Colorectal Cancer (Diagnosis), Lung Cancer Diagnosis, Prostate Cancer Diagnosis
Conditions
Brief summary
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. The primary aims are to study the intervention and determine its effectiveness on telehealth engagement, clinical quality, and healthcare cost outcomes across personal characteristics.
Detailed description
Study staff will use the Veterans Health Information Systems and Technology Architecture (VistA), the VA health information technology system, to identify eligible patients at VA sites based on listed inclusion and exclusion criteria. Patient records will be observed of Veterans with a new cancer diagnosis of the lung, prostate, breast, or colon and a telehealth visit utilizing the VA National TeleOncology Service (NTO).
Interventions
BEHAVIORALNational TeleOncology
Medical and/or subspecialty oncology care offered via facility-to-facility telehealth as an alternative to usual in-person care at the nearest VA or community oncology care setting offering similar services.
Sponsors
NYU Langone Health
National Cancer Institute (NCI)
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients Inclusion Criteria: 1. A Veteran 2. Aged 18 years or older 3. Newly diagnosed with lung, prostate, breast, or colon cancer within 3 months of telemedicine visit 4. Engaged in an oncology visit during the 36-month analysis period at a Veterans Affairs Medical Center (VAMC) location. VAMC Providers and Staff Inclusion Criteria: 1. Provider or staff member at one of the VAMC locations including physicians, nurse practitioners, physicians' assistants, and nurses caring for Veterans 2. Providers or staff members having helped provide care for at least 5 Veterans with cancer in the previous 6 months at a VAMC location Patients
Exclusion criteria
1. Veterans who have not seen any providers in the VA within the past year 2. Patients previously diagnosed with lung, prostate, breast, or colon cancer 3. Pregnant patients VAMC Providers and Staff
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of raw telehealth visits | Post-NTO implementation (up to 3 months) | Telehealth utilization among Veterans with cancer will be measured through raw telehealth visit counts. |
| Fraction of patients engaging in at least one telehealth visit | Post-NTO implementation (up to 3 months) | Telehealth utilization among Veterans with cancer will be measured by fraction of patients engaging in at least one telehealth visit. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in provider level Quality Oncology Practice Initiative (QOPI) score | Pre-implementation, post-NTO implementation (up to 3 months) | The quality of care of the intervention will be evaluating utilizing the American Society of Clinical Oncology Practice Initiative (QOPI) performance measures. The scale consists of 26 performance measures assessed at the patient, provider, and facility levels. Each cancer care provider will have his or her patient QOPI measures aggregated together for a provider level QOPI score. Our primary interest is the difference in QOPI score by intervention condition, as estimated by the fixed-effect coefficient for the intervention indicator variable. Scores of 75% or more indicate the standard is met, scores less than 75% indicate the standards have not been met. An increase in the QOPI score indicates improvement. |
| Time of consultation to time of first appointment | Pre-implementation, post-NTO implementation (up to 3 months) | Time to care will be measured through time of consultation to time of first appointment. |
| Time of consultation to time of first treatment | Pre-implementation, post-NTO implementation (up to 3 months) | Time to care will be measured through time of consultation to time of first treatment. |
| Average total cost for cancer diagnosis, treatment and downstream HealthCare utilization | Post-NTO implementation (up to 3 months) | — |
Countries
United States
Contacts
CONTACTJaneth Juarez Padilla
CONTACTNavid Dardashti
PRINCIPAL_INVESTIGATORDanil Makarov, MD, MHS
NYU Langone Health
Outcome results
None listed