CONNECT: COmpreheNsive traiNing and Engagement in Cessation Treatment

连接：戒烟治疗的综合培训和参与

• 批准号: 10295696
• 负责人: Steffani R Bailey
• 金额: $ 66.03万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10295696
• 关键词: Academic Detailing; Address; Adult; Back; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Cluster randomized trial; Collaborations; Communities; Counseling; Data; Effectiveness; Electronic Health Record; Enrollment; Ensure; Feedback; Goals; Health; Health Personnel; Healthcare; Household; Hybrids; Income; Individual; Inequality; Intervention; Knowledge; Medicaid; Methods; Morbidity - disease rate; National Cancer Institute; Neighborhood Health Center; Oregon; Outcome Study; Patient Self-Report; Patients; Performance; Persons; Pharmaceutical Preparations; Physicians; Population; Primary Health Care; Procedures; Process; Provider; Public Health; Randomized; Randomized Controlled Trials; Reporting; Research Priority; Services; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Standardization; System; Telefacsimile; Tobacco; Training; Uninsured; United States; Vulnerable Populations; base; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; design; effectiveness evaluation; evidence base; experience; health care settings; health information technology; implementation strategy; improved; incremental cost-effectiveness; individual patient; innovation; mortality; outreach; participant enrollment; patient oriented; pragmatic trial; primary care setting; programs; quitline; recruit; service utilization; smoking cessation; smoking prevalence; socioeconomic disadvantage; tobacco user; treatment guidelines; uptake

PROJECT SUMMARY Adult smoking prevalence in the United States (US) is approximately 14% nationwide, yet significant disparities persist, including among adults with annual household incomes <$35,000 (21.3%), Medicaid recipients (23.9%), and the uninsured (23.9%). These populations are also less likely to receive smoking cessation assistance and to use evidence-based cessation interventions. Many public health agendas emphasize addressing these inequalities to reduce smoking related morbidity and mortality. To do this, we need to increase accessibility to cessation services among these populations. Community health centers (CHCs) are ideal settings to reach smokers who are socioeconomically disadvantaged as they provide care to 29 million patients, the majority of whom are uninsured or publicly insured. Integrating Quitline referrals into these settings has the potential to reach a large number of smokers. Bidirectional eReferral systems, which allow providers to send a referral directly to the Quitline from the electronic health record (EHR) and Quitlines to send information about the patient's disposition back into the patient's individual EHR, provide a platform for more efficient and standardized referral systems. This method has increasedQuitline reach compared to faxed orindirect referral methods; however,the Centers for Disease Control and Prevention's goal for Quitlines to reach 8% of all tobacco users annually has not been met. A critical knowledge gap exists in how best to implement Quitline eReferral systems into health care settings to maximize the reach and effectiveness of cessation services. Enhanced academic detailing, which includes educational outreach and performance audit and feedback, can increase the use of best practices and the uptake of new processes and procedures among health care providers; however, in-person and ongoing enhanced academic detailing is infrequently used for Quitline referral implementation. Almost half of all US states report no staff training related to their provider referral programs. This cluster-randomized trial will recruit 30 Oregon CHCs (n~15,000 patients who smoke). Half of the clinics will be randomized to receive the Quitline eReferral system with enhanced academic detailing (intervention condition; n=15 clinics) and half to receive the Quitline eReferral system without enhanced academic detailing (comparison condition; n=15 clinics). This pragmatic trial will use EHR and Quitline data to assess rates of smoking cessation assistance reach and effectiveness among patients in the intervention clinics compared with rates among patients in the comparison clinics. We will also evaluate the cost-effectiveness of the eReferral system, both with and without enhanced academic detailing. This scalable intervention has high potential to increase accessibility to smoking cessation treatment through the collaboration between state Quitlines and CHCs that serve large numbers of socioeconomically disadvantaged smokers. This study addresses the National Cancer Institute's research priority of developing targeted and scalable interventions to reduce smoking among this vulnerable population.

项目概要 美国 (US) 全国成人吸烟率约为 14%，但差异显着 持续存在，包括家庭年收入 < 35,000 美元的成年人 (21.3%)、医疗补助受益人 (23.9%) 和没有保险的人 (23.9%)。这些人群也不太可能戒烟 援助并使用基于证据的戒烟干预措施。许多公共卫生议程强调 解决这些不平等问题，以减少与吸烟有关的发病率和死亡率。为此，我们需要 增加这些人群获得戒烟服务的机会。社区卫生中心 (CHC) 是 为 2,900 万人提供护理，为社会经济处于不利地位的吸烟者提供理想的环境 患者，其中大多数没有保险或公共保险。将戒烟热线转介整合到这些中 环境有可能接触到大量吸烟者。双向电子转诊系统，允许 提供者从电子健康记录 (EHR) 和戒烟热线直接向戒烟热线发送推荐 将有关患者性格的信息发送回患者的个人 EHR，提供一个平台 更高效、标准化的转诊系统。与传真相比，这种方法增加了戒烟热线的覆盖范围 或间接转介方法；然而，疾病控制和预防中心的戒烟热线目标是 每年达到所有烟草使用者的 8% 尚未实现。在如何最好地做到这一点方面存在着关键的知识差距 在医疗机构中实施戒烟热线电子转诊系统，以最大限度地提高戒烟热线的覆盖面和有效性 戒烟服务。增强学术细节，包括教育推广和绩效审核 和反馈，可以增加最佳实践的使用以及新流程和程序的采用 医疗保健提供者；然而，面对面和持续增强的学术细节很少用于 实施戒烟热线转介。美国几乎一半的州报告称没有与其提供商相关的员工培训 推荐计划。这项整群随机试验将招募 30 名俄勒冈州 CHC（约 15,000 名吸烟患者）。 一半的诊所将随机接受戒烟热线电子转诊系统并增强学术水平 详细说明（干预条件；n=15 个诊所），一半接受戒烟热线电子转诊系统，无需 增强学术细节（比较条件；n=15 家诊所）。这项务实的试验将使用 EHR 和 用于评估戒烟援助覆盖率和有效性的戒烟热线数据 干预诊所与对比诊所患者的比率进行比较。我们还将评估 电子推荐系统的成本效益，无论是否有增强的学术细节。这种可扩展的 干预很有可能通过以下方式增加戒烟治疗的可及性 州戒烟热线与为大量社会经济弱势群体提供服务的社区卫生中心之间的合作 吸烟者。这项研究涉及国家癌症研究所的研究重点，即开发有针对性的和 可扩展的干预措施，以减少这一弱势群体的吸烟。