Randomized controlled trials by Basch (collaborator) and colleagues demonstrated that
weekly electronic home-based PRO symptom monitoring with automated alerts to clinicians
(Home ePRO) in cancer patients was associated with reduced healthcare utilization,
improved quality of life, and increased overall survival. However, these trials were
administered using infrastructure supported by research funding. A knowledge gap remains
about optimal implementation strategies for and effectiveness of Home ePROs in real-world
settings. To address this gap, investigators from two institutions will conduct a
large-scale population-based implementation of an evidence-based Home ePRO intervention
for all adult cancer patients receiving chemotherapy, including vulnerable populations
such as African Americans, rural residents, and socioeconomically disadvantaged
individuals. This implementation will leverage infrastructure from Medicare's payment
reform projects (Oncology Care Model, Oncology Care First Model), which require and
financially support patient navigators, a natural workforce for Home ePRO implementation.
The investigators' hypothesis is that the deployed implementation strategies will result
in successful navigator-delivered Home ePRO, which will improve both patient and health
system outcomes. Using the Consolidated Framework for Implementation Research (CFIR),
this hypothesis will be tested using a hybrid type 2 design with three specific aims: 1)
evaluate implementation of navigator-delivered Home ePRO for all cancer patients across
multiple practice sites; 2) examine the barriers, facilitators, and implementation
strategies used in implementing navigator-delivered Home ePRO; and 3) assess the impact
of Home ePRO on clinical and utilization outcomes. In Aim 1, Home ePRO will be evaluated
using implementation outcomes (service penetrance, provider adoption/penetration,
intervention fidelity). In Aim 2, the investigators will gauge patient and healthcare
team perceptions of barriers, facilitators of navigator-led Home ePRO, implementation
strategies used to address these barriers, implementation strategy fidelity, and
perception of implementation strategy ability to address barriers using an iterative
qualitative analysis. In Aim 3, patient-level outcomes (functional status, distress,
depression, healthcare utilization, cost, survival) will be evaluated using real-world
data sources. The project is innovative because it will be the first study to evaluate
real-world implementation of navigator-led Home ePRO for all cancer patients receiving
chemotherapy, an approach that is both immediately scalable and sustainable within
value-based payment models. The proposed research is significant because it is expected
to demonstrate successful implementation of navigator-delivered Home ePRO and
effectiveness of the ePRO intervention on diverse patient populations. Furthermore, the
project will generate an implementation blueprint of successful implementation strategies
that can be easily applied to other patient-reported outcomes, with the potential to
positively impact patient care as health care transitions to a value-based system.