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248 Patient-Centered Coordinated Cancer Care System

Number of anticipated awards: 3
(Fast-Track proposals will not be accepted.)
Budget (total costs): Phase I: $150,000;
Phase II: $1,000,000
Project duration: Phase I: 9 months;
Phase II: 2.5 years

The deadline for receipt of all contract proposals submitted in response to this solicitation is: 5:00 p.m. Eastern Standard Time Monday, November 5, 2007

The goal of this project is to develop an automated care coordination program that will 1) allow all cancer care team members to view and participate in the coordination of cancer care during the diagnostic process, 2) assist patients in seeking needed evaluation of an abnormality, and 3) track relevant patient health status, outcomes data, symptom management recommendations, and decision points in real time and in full view of the patient and care team. This represents a slight modification of the 2006 version of this contract topic that focused on the palliative care process rather than the diagnostic process.

The 2006 version of this SBIR topic focused on using the Veteran's Health Administration VHA's electronic medical record (VISTA) as an infrastructure to which mobile technology linked care coordinators and patients managing cancer symptoms and pain.(2007,2002) Access to community resources, coordination of communication among providers, and the facilitation of dialogue during an evolving stage of care were all requirements underlying implementation of this mobile technology and were addressed in the first version of this SBIR initiative to replicate the VHA's symptom management technology for use in the community. The requirements address care needs at many points in the Cancer Care Continuum.(2003) For example, VISTA has shown promise for the effective management of primary care patients and implementation of cancer screening in populations served by Federally Qualified Health Centers (FQHC) but the coordination of community resources, and communication among providers are critical needs during the diagnostic process as well.(2003,2005,2006) This current topic builds on the experience with the symptom management and Vista system and FQHCs to provide patient-centered bridging technology that gives patients the information they need, when they need it so they can successfully navigate through the diagnostic process between an abnormal cancer screening test or symptomatic presentation and its resolution as a benign abnormality or a cancer diagnosis.

Of the1,358,030 new cancer cases in the US in 2005 (2005), a disproportionate burden was borne by the uninsured and underinsured who were eligible to seek care in 1365 FQHC's that existed in the US and served more than 14 million people.(2007). The populations served by these centers bear a disproportionate cancer burden and had lower levels of screening for breast (58% vs. 70%), cervical (69% vs 82%), and colon cancer (20% vs 40%) compared to the general population.(2003,2004,2000) Work to close these gaps has been encouraged through collaboration between the NCI, Centers for Disease Control, Health Resources and Services Administration(HRSA) and FQHCs in the Cancer Collaborative (CC).The CC approach to planning cancer screening process in health centers has now been proposed as a general process in HRSA's efforts to address health disparities.(2007) The work of the NCI with the VHA and HRSA's Health Disparities Collaboratives can serve as a foundation for developing technology that coordinates cancer care of people served by FQHCs.

The VA/NCI home centered coordinated cancer care system holds promise for the thousands of Veterans who have cancer and people who are at an earlier point in the cancer care continuum. We expect this current project to standardize and extend the model to others outside the VA, including those served by FQHCs.

NOTE: The National Cancer Institute (NCI) promotes the use of state-of-the-art media technology to develop tools, interventions, programs and systems that 1) are needed by professionals or the public to reduce cancer risk or improve the quality of life of cancer survivors; 2) help fill gaps in research; 3) resolve barriers to use so that products can be used effectively in medical and community settings; and 4) improve communication behaviors between primary care professionals and patients/care-givers in cancer-related matters.

Phase I activities and expected deliverables:

  • Develop a system prototype that registers referrals, appointments, and all patient-provider and provider-provider communication throughout the coordination of the diagnostic process.
  • The software prototype should include a real time visual simulation of the coordination process with alerts, reminders and other signals that support the patient's progress, the accountability of individual team members, and the integrity of the entire coordination effort.
  • This program must be capable of integrating into a larger system of home based coordinated cancer care; avoid redundant documentation.
  • 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 includes providers in FQHCs who will conduct cancer care coordination during the diagnostic process.
  • Conduct interviews with team members and selected community participants to develop a set of use case scenarios (from first abnormality (abnormal screening test or symptomatic presentation in a physician's office through diagnosis for one cancer type) that will serve as the basis of the coordination simulation software program.
  • 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.
  • Provide a report detailing the coordination tracking program design, including 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 working prototype of the cancer care coordination tracking program.
  • Include in the proposal, letters of agreement from organizations participating in Phase I feasibility testing and evaluation.
  • Obtain letters of agreements from appropriate community participants to participate in the testing and evaluation of the final product in the Phase II.
  • Present Phase I findings and demonstrate the final prototype to an NCI Evaluation Panel.

NOTE: Offerors are required to fully develop their individual product in Phase II to meet the goals of this SBIR contract topic. Where feasible and appropriate, Phase II contractors may be required to collaborate, coordinate, or communicate with other NCI funded contractors or programs. Offerors are also required to develop a dissemination package that enhances marketability.

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 (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 (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 year of the contract, provide the program and contract officers with a letter of commercial interest.
  • In the second year of the contract, provide the program and contract officers with a letter of commercial commitment.
  • Include $24,000 in the budget for evaluation of the product at NCI's Evaluation Lab.
  • Present final research findings and demonstrate the final product at an NCI/DCCPS sponsored Product Showcase.
  • Prepare at least one manuscript describing the development and evaluation of the system for publication in a peer-reviewed scientific journal.
  • Submit final report in the template provided by the NCI program officer.

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