Telehealth Research Center of Excellence (TRACE) at the University of Pennsylvania

DESCRIPTION 

The University of Pennsylvania (Penn) Telehealth ReseArch Center of Excellence (Penn TRACE), based at the Penn Center for Cancer Care Innovation (PC3I) at the Abramson Cancer Center, is one of four National Cancer Institute (NCI) Telehealth Research Centers of Excellence dedicated to advancing the nation’s telehealth research agenda focused on improving cancer-related care and outcomes. With support from the White House Cancer Moonshot, Penn TRACE applies insights from communication science and behavioral economics to design and test innovative telehealth approaches to improve effectiveness and equity across the cancer care continuum, with an emphasis on advancing health equity and addressing the digital divide.

The researchers will look specifically at lung cancer across its care continuum, examining ways that telehealth can transform care delivery of this single largest cause of cancer death in the US. The Penn TRACE researchers will conduct rapid tests of innovative telehealth approaches linked with pragmatic randomized trials within the real-world clinical services across Penn’s Primary Care and Cancer Network. The center’s main trial will compare the effectiveness of telehealth strategies to increase shared decision making for lung cancer screening, while a second trial will test a telehealth strategy for patients with advanced lung cancer to improve timely treatment recommendations through early integration of plasma-based molecular testing. 

Penn TRACE is comprised of a pragmatic trial, several pilot studies, and a Research and Methods Core, an Administrative Core, and a Clinical Practice Network. The research will field other trials in later years of the program.

Pragmatic Trial. The pragmatic trial will compare the effectiveness of telehealth strategies to increase shared decision making for lung cancer screening using a Sequential Multiple Assignment Randomized Trial (SMART) design.

Pilot Study. The first of two pilot studies will test a telehealth strategy for patients with advanced lung cancer to improve timely treatment recommendations through early integration of plasma-based molecular testing.

Research and Methods Core. The Research and Methods Core will ensure consistency in measurement and analytic approaches with regards to the Center’s five essential endpoints – access, quality, outcomes, equity, and efficiency – and will pool data to test the robustness of findings from individual projects.

Administrative Core. The Administrative Core will provide overarching scientific and operational oversight that includes strategic planning, facilitating communications among the investigative team, supporting training and mentorship opportunities, overseeing the dissemination of results, monitoring and evaluating Center progress, and providing overall administrative, budgetary, and regulatory oversight.

Clinical Practice Network. The Clinical Practice Network will provide a natural ecosystem of community and academic clinical sites to conduct the pragmatic trial and pilot studies across the lung cancer care continuum. It will also provide a hub to integrate the work of existing clinical and operational leaders at Penn Medicine with the telehealth, clinical informatics, and data infrastructure needed to ensure successful completion of the pragmatic trial and pilot projects.

Junior Investigator Program. Penn TRACE is committed to offering opportunities for junior scientists, graduate students, postdoctoral researchers, and other trainees to break new ground in telehealth, cancer care, and health equity research. Pursuant to that goal, the Penn TRACE Junior Investigator Program was established to foster mentorship and engagement among junior researchers and trainees who have interests at the intersection of cancer control and telehealth. In addition to receiving ongoing mentorship from senior investigators and board members, junior investigators are included in project meetings where relevant scientific topics are presented and discussed.

The work of Penn TRACE is grounded in several foundational concepts, strategies, tools, and methods.

Communication Science. The work of Penn TRACE will be designed to support and evaluate the six core functions of patient-centered communication – fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient self-management.

Behavioral Economics. Penn TRACE has identified the need to improve cancer care delivery by addressing mental heuristics with small behavioral tweaks known as nudges, and organizes these nudges as a ladder of interventions targeted to patients and clinicians to impact behavior.

Advancing Health Equity. To ensure our strategies reduce, rather than exacerbate persistent inequities in lung cancer, Penn TRACE will assess how individual and social determinants intersect with communication inequities and other multilevel factors to shape telehealth effectiveness and equity. To guide this work, Penn TRACE has developed its own overarching conceptual framework, named the Framework for Integrating Healthcare Equitably (FITE).

Telehealth. Penn TRACE is embedded in the extensive telehealth and EHR infrastructure of Penn Medicine and leverages both synchronous and asynchronous telehealth infrastructure, including text messaging platforms used for clinical care and research.

Innovation. Innovation methods drawn from industries outside of healthcare are integral to the proposed work of Penn TRACE, and can inform new care delivery models by rapidly de-risking or optimizing the design of the intervention.

IMPACT 

Penn TRACE will integrate communication science and behavioral economics to better understand telehealth delivery for cancer care and potentially close gaps or inequities in cancer care delivery.

PEOPLE 

Justin Bekelman, MD; Katharine Rendle, PhD, MSW, MPH; Anil Vachani, MD, MS; Charu Aggarwal, MD, MPH;  David Asch, MD, MBA;  Angela Bradbury, MD; Sarah Beucker, MPH; Christopher Caruso, MD, MPH; Tessa Cook, MD, PhD; David Dougherty, MD, MBA; Peter Gabriel, MD, MSE; Zachary Gething, BA; Karen Glanz, PhD, MPH;  Carmen Guerra, MD, MSCE;  Rebecca Hubbard, PhD;  Ann Huffenberger, DBA, RN, NEA-BC; Linda Jacobs, PhD, CRNP; Kevin Johnson, MD, MS; Jillian Kalman, BA; Pallavi Kumar, MD, MPH;  Frank Leone, MD, MS; Kristin Linn, PhD; Judith Long, MD; Anthony Martella, BA; Shivan Mehta, MD, MBA, MSHP; Christina O’Malley, MHA; Matthew Press, MD, MSc; Corinne Rhodes, MD, MPH; Debra Ritzwoller, PhD;  Marilyn Schapira, MD, MPH;  Robert Schnoll, PhD;  Lawrence Shulman, MD; Anna Jo Smith, MD, MPH, MSc; Alisa Stephens-Shields, PhD;  Jennifer Steltz, BS; Andy Tan, PhD, MPH, MBA, MBBS;  Samuel Takvorian, MD, MSHP;  Joseph Teel, MD; Jeffrey Thompson, MD; Hannah Toneff, MSW, MA; Jocelyn Wainwright, MS; Richard Wender, MD