在瘤学 (E2C2) 中,电子健康记录促进了症状监测和协作护理干预 (E2C2):一个集群随机化,人口级别,阶梯式,实用性的试验
Andrea L Cheville1, Jeph Herrin2, Deirdre R Pachman3
1Department of Physical Medicine and Rehabilitation Research, Mayo Clinic, Rochester, MN, USA.
The Lancet. Oncology
|December 4, 2025
概括
电子健康记录 (EHR) 促进患者报告结果措施 (PROM) 监测和协作护理,减少瘤患者的症状负担. 这种方法在改善癌症治疗结果方面比单独的症状监测更有效.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 数字健康数字健康
背景情况:
- 患者报告的结果措施 (PROMs) 和协作护理提高了癌症症状管理,但面临着资源限制.
- 电子健康记录 (EHR) 便利化提供了一个可扩展的解决方案,以减少PROM监测和协作护理的资源需求.
- E2C2试验评估了EHR促进的PROM导向协作护理对瘤病人的临床和医疗服务结果的影响.
研究的目的:
- 评估电子PROM (ePROM) 结合电子PROM (ePROM) 的EHR促进协作护理的有效性,与通常的护理 (单独使用ePROM监测) 相比.
- 确定这项干预措施对大量瘤患者群体的症状负担和临床可操作的症状得分的影响.
主要方法:
- 一个随机集群,阶段,实用试验 (E2C2) 试验,涉及15个美国瘤和血液学诊所,使用Epic EHR系统.
- 收到医疗瘤学或血液学护理的患者被纳入,顺序从常规护理 (UC) 过渡到EHR促进的协作护理 (ECC) 在8个月间隔内.
- 症状评估包括SPPADE症状 (睡眠干扰,疼痛,身体功能受损,焦虑,抑郁,疲劳) 使用数值评分表,通过多变量回归分析结果.
主要成果:
- 超过5万名患者被纳入;24874人组成了分析队列,其中85%报告至少有一个可采取行动的症状 (得分≥4/10).
- 与UC期间相比,EHR促进的协作护理 (ECC) 期间显示,与UC期间相比,平均人口联合SPPADE症状负担显著减少 (p=0.0055).
- 有利于ECC的特定症状改善包括焦虑 (-0.12),抑郁 (-0.08) 和疲劳 (-0.06),对于可操作的症状得分也观察到显著的好处.
结论:
- 集中式的EHR促进的症状监测和协作护理管理比单独的症状监测更有益.
- 这种综合方法有效地减少了瘤病患者关键症状的人口负担.
- 促进EHR使得癌症症状管理的可扩展,资源高效的改进成为可能.
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