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235 Home Centered Coordinated Cancer Care System

Number of anticipated awards: 1-2
(Fast-Track proposals will not be accepted.)
Budget (total costs): Phase I: $150,000;
Phase II: $750,000

The deadline for receipt of all contract proposals submitted in response to this solicitation was:
5:00 p.m. Eastern Standard Time
Monday, November 6, 2006

The Veterans Health Administration, with its enterprise wide computerized patient record, telehealth technologies and coordinated care model, offers a working prototype of a home based system of coordinated care for chronic conditions. The VHA, in partnership with NCI, has developed a system of coordinated cancer care made up of these components. This system has shown promise for the effective management of symptoms and high quality of life during cancer treatment. It has the additional potential of saving costs due to unnecessary institutionalization. The health information infrastructure that supports this system requires a high level of interoperability as does the human communication processes that make the coordination among the team seamless and dependable. The VA/NCI cancer care coordination processes are similar to disease management processes. They are led by a professional care coordinator who brings community resources to bear upon the various symptoms as they are experienced by the patient. The care coordinator is responsible for monitoring the patients' symptoms on a daily basis and providing feedback regarding appropriate self or professional symptom management actions given the patient's current status. The patient and/or informal caregiver is responsible for answering daily questions and implementing self care symptom management. Daily patient/provider dialogue is supported by a telehealth program that is linked to the VA's computerized health record.

The goal of this project is to develop an automated coordination tracking program that will allow all cancer care team members a view of the VA/NCI cancer care coordination processes. An automated cancer care coordination tracking program will track health status and outcomes data, symptom management recommendations, interventions and decision points in real time and in full view of all team members. It will register handshakes (responsibility hand-offs) and all feedback loops throughout the coordination of a given activity. Ideally this software should include a real time visual simulation of the coordination process with alerts, reminders and other signals that support the accountability of individual team members and the integrity of the entire coordination effort. This program is not to be a stand alone product but should be integrated into a larger system of home based coordinated cancer care.

In early 2003 the NCI announced its goal of "eliminating the suffering and death due to cancer by 2015." There is an expected total of 1,358,030 new cancer cases in the US in 2005 (Jemal, Murray, & Ward, 2005). Among 19 million outpatient visits made by cancer patients each year, chemotherapy is administered in approximately 22% of those visits (Hewitt & Simone, 1999). Cancer chemotherapy successfully treats many cancer cells, but causes severe symptoms, such as fatigue, pain, and nausea (Mooney, Beck, & Friedman, 2002). Uncontrolled symptoms, many of which can be profound and are primarily experienced by patients at home, are associated with a reduction in health-related quality of life (HRQL) (Cooley, Short, & Moriarty, 2003; Mooney et al., 2002). A recent study of 117 lung cancer patients found that many symptoms (e.g., pain and fatigue) decreased from 0 to 3 months, but from 3 to 6 months pain and fatigue increased markedly (Cooley et al., 2003). Patients' quality of life is too often compromised as a result of either the cancer and/or its treatment (Hammerlid, Silander, & Hornestam, 2001). The current standard of practice for managing symptoms during chemotherapy is for a health provider to address them when the patient comes in to the hospital or clinic for treatments, sometimes days or weeks apart (NIH, 2002).

In an effort to reduce suffering due to cancer and its treatment's side effects in a more effective manner, the Health Communication and Informatics Research Branch in the Division of Cancer Control and Population Studies at NCI has partnered with the Veterans Health Administration (VHA) to develop and test a model of coordinated cancer care. We have designed, implemented, and tested a working model based upon a systems view of human communication and informatics and upon the VA's Community Care Coordination Service model (Harris, L; Kobb, R; Ryan, P; Darkins, A; Kreps, G. "Research as Dialogue: Health Communication and Behavior Change in Patients' Natural Habitat" in Whitten, P and Cook, D (Eds) Understanding Health Communication Technologies. San Francisco, Jossey Bass. Pp91-100; Chumbler, N; Richardson, L; Harris, L, et al. "Cancer Care Dialogues: Empirical Support for Complex Adaptive Systems Research and Practice" in Whitten, P., Kreps, G.L., & Eastin, M. (Eds.). (2006, In press). Advances in Cancer Online Information Services. Cresskill, NJ: Hampton Press; Meyer, M; Kobb, R; and Ryan, P. "Virtually Healthy: Chronic Disease Management in the Home" Disease Management, Vol 5, No.2, 2002, pp87-94.

The VA/NCI home centered coordinated cancer care system holds promise for the thousands of Veterans who have cancer. We expect this project to standardize and extend this model to others outside the VA.

Phase I Activities and expected deliverables:

  • Review the VA/NCI cancer care coordination model, other coordination protocols and relevant literature to develop an overall cancer coordination process model;
  • Establish a team or set of teams that will conduct cancer care coordination, including their roles and responsibilities;
  • Conduct interviews with team members and selected community participants to develop a set of use case scenarios (from diagnosis through survivorship/death for one cancer type) that will serve as the basis of the coordination simulation software program;
  • Provide a report detailing the coordination tracking program design, including a theoretical and methodological bases for the evaluation;
  • Provide a set of use case scenarios that have been approved by members of the team for tracking;
  • Develop a prototype of the cancer care coordination tracking program;
  • Obtain letters of agreements from appropriate community participants to participate in the testing and evaluation of the cancer coordination system in the Phase II;
  • Convene focus groups or conduct interviews with potential end-users of the system to determine if the system contents, format, etc. are appropriate for ease of use.
  • Develop a working prototype of the system.
  • Include travel funds to present Phase I findings and demonstrate product prototype to an NCI Evaluation Panel.

Phase II Activities and expected deliverables:

  • Complete 2 iterations of the tracking program software, including technical documentation of the system and a training manual;
  • Develop evaluation measures;
  • Evaluate and refine the program based upon user feedback;
  • Integrate the tracking program into a telehealth monitoring and computerized patient record;
  • Test and evaluate the complete system serving cancer patients and their care coordination team using process and outcome measures as described above;
  • System Requirements include:
    • Embedding the tracking software into a home telehealth monitoring and reporting system based upon the VA/NCI model of home centered coordinated cancer care; this could involve partnering or licensing with other vendors or developers of these components.
    • Integrating the home centered coordinated cancer care system into a community's existing IT infrastructure using the IT interoperability standards offered by The U.S. Department of Health and Human Services (http://www.hhs.gov/healthit). Eligible communities are those that have been funded by The Foundation for eHealth Initiative which provides seed funding and support to multi-stakeholder collaboratives within communities (both geographic and non-geographic) who are using electronic health information exchanges (HIE) and other information technology tools to drive improvements in healthcare quality, safety, and efficiency (http://www.ehealthinitiative.org).
    • Evaluating the system in a real community setting, according to cost, quality of care, quality of life and access outcome measures in addition to the community's own health and IT standards. Community members should be included in the research and development team from the beginning of the research and development project.
  • In the first six months of the first year of the contract, provide the program and contract officers with a letter of commercial interest.
  • In the first six months of the second year of the contract, provide the program and contract officers with a letter(s) of commercial commitment based on the successful outcome of the Phase II.
  • Include $24,000 in the budget for an independent vendor to evaluate the final product.
  • Include sufficient travel funds for the P.I. to participate in an NCI/DCCPS SBIR Showcase.
  • Prepare at least one manuscript describing the development and evaluation of the product for publication in a peer-reviewed scientific journal.
  • Submit final report in the template provided by the NCI program officer.

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