Comparative Effectiveness of Post-Discharge Strategies for Hospitalized Smokers

住院吸烟者出院后策略的比较效果

基本信息

批准号：
10202694
负责人：
NANCY A RIGOTTI
金额：
$ 79.13万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-03-07 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10202694
关键词：
Address Adopted Adult Affordable Care Act Aftercare American Back Biochemical Caring Cause of Death Chronic Care Clinical Clinical Trials Collaborations Counseling Data Effectiveness of Interventions Electronic Health Record Enrollment Feedback Guidelines Hand Health Health system Healthcare Healthcare Systems Home Hospital Mortality Hospitalization Hospitals Incentives Intervention Joints Lead Life Expectancy Link Measures Medical Care Team Medicare Medicare/Medicaid Modeling Motivation Outcome Outcome Measure Outpatients Patient Care Patients Pharmaceutical Preparations Policies Population Prevalence Public Health Informatics Randomized Randomized Controlled Trials Reporting Research Research Design Resources Risk Secure Site Smoke Smoker Smoking Smoking Cessation Intervention Standardization System Technology Telephone Testing Text Messaging Time Tobacco Tobacco Use Cessation Tobacco use Translating United States Public Health Service Voice Work active method arm base care coordination cigarette smoking clinical practice comparative effectiveness comparative effectiveness trial compare effectiveness cost cost effective cost effectiveness design effective therapy efficacy research evidence base experience follow-up health care service utilization health care settings health management hospital readmission implementation fidelity improved innovation intervention effect meetings member mortality new technology nicotine replacement population health preference programs quitline response smoking cessation smoking intervention standard care telephone coaching theories tobacco abstinence tobacco cessation intervention tool treatment group uptake

项目摘要

Cigarette smoking is the leading preventable cause of death in the U.S. The U.S. Public Health Service Smoking Cessation Guideline recommends offering effective treatment that includes both medication and counseling to smokers in all health care settings, including hospitals. Nearly 4 million smokers are hospitalized each year, and hospital admission offers a “teachable moment” for intervention. In-hospital smoking cessation intervention is efficacious, but only if contact continues for more than 1 month after discharge. The challenge is to translate this efficacy research into clinical practice. Sustaining treatment after discharge is the major barrier to identifying a scalable, sustainable, cost-effective model for U.S. hospitals. Building on our prior work, this competitive renewal project compares the effectiveness of 2 innovative strategies that aim to sustain treatment after discharge. Both interventions are integrated into the electronic health record (EHR) and leverage technology to engage patients and streamline the delivery and uptake of evidence-based tobacco cessation treatment, but they differ in intensity and resources required. Specific Aim: To compare the effectiveness and cost-effectiveness of 2 interventions to increase hospitalized smokers’ long-term tobacco abstinence after discharge. Study Design: A multi-site randomized controlled comparative effectiveness trial will enroll 1350 adult smokers admitted to 3 hospitals in 3 states (MA, PA, and TN). All subjects will have a standardized in- hospital smoking intervention and be randomly assigned at discharge to Personalized Tobacco Care Management (PTCM) or Quitline eReferral (eReferral). PTCM, built on our prior work, offers smokers 4 weeks of free nicotine replacement therapy (NRT) in hand at discharge (refillable x 1) and 7 proactive automated contacts over 3 months via their preference of interactive voice response (IVR) phone calls or text messages. Each contact promotes cessation and offers access to a tobacco coach based in the health system who coordinates treatment with the smoker’s health care team via the EHR. eReferral is a less intensive, lower cost option in which smokers receive a one-time automated referral from the EHR to the state quitline at discharge. The quitline offers multi-session telephone counseling, 4 weeks of free mailed NRT, and sends a feedback report to the EHR. Outcomes, assessed at 1, 3, and 6 months after hospital discharge, are: (1) intervention effectiveness (biochemically-validated past 7-day tobacco abstinence at 6 month follow-up [1o outcome] and other tobacco abstinence measures); (2) smoking cessation treatment utilization, and (3) cost- effectiveness (incremental cost per quit). We will explore the interventions’ effects on hospital readmissions and mortality after discharge. Impact: New National Hospital Quality Measures (NHQM) adopted by Medicare and Medicaid programs include tobacco treatment measures, giving hospitals an incentive to adopt these interventions. Completion of this study will provide critical cost and effectiveness data to guide hospitals as they develop strategies to comply with NHQM, reduce patients’ smoking, and improve clinical outcomes.

吸烟是美国主要的可预防死亡原因美国公共卫生服务戒烟指南建议提供有效的治疗，包括药物治疗和在所有医疗机构（包括医院）为吸烟者提供咨询服务近 400 万吸烟者住院治疗。每年，住院都提供了进行院内戒烟干预的“教学时刻”。干预是有效的，但前提是出院后接触持续超过 1 个月。挑战是。将这项疗效研究转化为临床实践是主要障碍。以我们之前的工作为基础，为美国医院确定一个可扩展的、可持续的、具有成本效益的模式。竞争性更新项目比较了两种旨在维持治疗的创新策略的有效性出院后，这两种干预措施都会集成到电子健康记录 (EHR) 中并发挥作用。吸引患者并简化循证戒烟的提供和接受的技术治疗，但它们的强度和所需资源不同。具体目标：比较有效性和效果。两种干预措施提高住院吸烟者长期戒烟率的成本效益出院研究设计：一项多中心随机对照有效性试验将招募 1350 名患者。成年吸烟者入住 3 个州（马萨诸塞州、宾夕法尼亚州和田纳西州）的 3 家医院，所有受试者都将接受标准化检查。医院吸烟干预并在出院时被随机分配到个性化烟草护理管理 (PTCM) 或戒烟热线电子转诊 (PTCM) 以我们之前的工作为基础，为吸烟者提供 4。出院时可免费使用数周的尼古丁替代疗法 (NRT)（可补充 x 1）和 7 周主动治疗通过他们对交互式语音应答 (IVR) 电话或短信的偏好在 3 个月内自动联系每个联系人都提倡戒烟，并提供与卫生系统内的烟草教练的联系。通过电子病历与吸烟者的医疗团队协调治疗的强度较低。成本较低的选择，其中吸烟者会收到从 EHR 到州戒烟热线的一次性自动转介戒烟热线提供多次电话咨询、4 周免费邮寄 NRT，并发送一份出院后 1、3 和 6 个月评估的结果反馈报告为：(1) 干预有效性（在 6 个月的随访中经过生化验证的过去 7 天的戒烟情况 [1o (2) 戒烟治疗的利用，以及 (3) 成本- 有效性（每次戒烟的增量成本）。我们将探讨干预措施对再入院的影响。影响：医疗保险采用的新国家医院质量措施 (NHQM)。医疗补助计划包括烟草治疗措施，从而激励医院采取这些措施完成这项研究将提供关键的成本和有效性数据来指导医院：他们制定了遵守 NHQM、减少患者吸烟并改善临床结果的策略。

项目成果

期刊论文数量（12）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Smoking Cessation After Hospital Discharge: Factors Associated With Abstinence.

出院后戒烟：与戒烟相关的因素。

DOI：
发表时间：
2018
期刊：
影响因子：
0
作者：
Streck, Joanna M;Chang, Yuchiao;Tindle, Hilary A;Regan, Susan;Park, Elyse R;Levy, Douglas E;Singer, Daniel E;Ylioja, Thomas;Rigotti, Nancy A
通讯作者：
Rigotti, Nancy A

Reducing Health Disparities by Tackling Tobacco Use.

通过解决烟草使用问题来减少健康差距。

DOI：
发表时间：
2017-09
期刊：
影响因子：
5.7
作者：
Rigotti, Nancy A;Kalkhoran, Sara
通讯作者：
Kalkhoran, Sara

2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents.

2018 年 ACC 戒烟治疗专家共识决策路径：美国心脏病学会临床专家共识文件工作组报告。

DOI：
发表时间：
2018-12-25
期刊：
影响因子：
24
作者：
Barua, Rajat S;Rigotti, Nancy A;Benowitz, Neal L;Cummings, K Michael;Jazayeri, Mohammad;Morris, Pamela B;Ratchford, Elizabeth V;Sarna, Linda;Stecker, Eric C;Wiggins, Barbara S
通讯作者：
Wiggins, Barbara S

烟草相关疾病、健康信念和出院后戒烟。

DOI：
发表时间：
2023-11
期刊：
影响因子：
5.5
作者：
Bernstein, Eden Y;Chang, Yuchiao;Levy, Douglas E;Baggett, Travis P;Lee, Scott S;Tindle, Hilary A;Rigotti, Nancy A
通讯作者：
Rigotti, Nancy A

Improvements in health-related quality of life among smokers who quit after hospitalization.

住院后戒烟的吸烟者与健康相关的生活质量得到改善。