Implementation of HIT-Enhanced Tobacco Treatment for Hospitalized Smokers

对住院吸烟者实施 HIT 强化烟草治疗

基本信息

批准号：
8337887
负责人：
Steven L Bernstein
金额：
$ 80.02万
依托单位：
YALE UNIVERSITY
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：
2012-08-06 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8337887
关键词：
18 year old Abstinence Academic Detailing Accounting Acute Acute myocardial infarction Admission activity Adult Age American Bupropion Caring Cessation of life Cigarette Clinical Practice Guideline Computerized Medical Record Congestive Heart Failure Consumption Cost Effectiveness Analysis Counseling Dependence Economics Education Effectiveness Electronics Emergency Medicine Evidence based intervention Evidence based treatment Goals Health Personnel Healthcare Hospitalists Hospitalization Hospitals Individual Inpatients Instruction Internal Medicine Intervention Joints Learning Measures Nurses Nursing Assessment Nursing Education Outcome Measure Outpatients Overweight Pamphlets Patient Discharge Patients Performance Pharmaceutical Preparations Pharmacotherapy Physical Examination Physicians Pneumonia Population Poverty Pregnancy Primary Health Care Provider Quality-Adjusted Life Years Race Recording of previous events Regulation Relative (related person)Reporting Research Personnel Resources Services Smoke Smoker Smoking Societies Source System Telefacsimile Telephone Text Time Tobacco Tobacco Dependence Tobacco use Training United States United States Centers for Medicare and Medicaid Services United States Public Health Service Workplace arm cigarette smoking cohort computerized physician order entry cost cost effective cost effectiveness economic cost evidence base experience follow-up health information technology implementation science improved meetings nicotine replacement novel prevent profession allied to medicine programs quitline randomized trial smoking cessation smoking prevalence standard of care tobacco abstinence tobacco control tobacco screening varenicline

项目摘要

DESCRIPTION (provided by applicant): Forty-six million US smokers account for 6-12 million hospitalizations each year. These admissions provide a teachable moment for tobacco control. Advances in health information technology (HIT), like electronic medical records (EMR), provide an opportunity to implement evidence-based, cost-effective, sustainable programs in tobacco treatment for hospitalized smokers. The overall goal of this proposal is to study the effectiveness of a novel Integrated Tobacco Order Set (ITOS), embedded within an EMR, in promoting sustained smoking abstinence in a cohort of adult inpatients. We propose a 2-arm trial, randomized by provider, of ITOS + Academic Detailing (AD) at Yale-New Haven Hospital (YNHH) compared to AD alone. Subjects admitted to physicians in the AD arm may receive a smoking cessation brochure and medications ordered electronically, our standard of care. Providers in the ITOS arm will access an electronic order set that includes: (1) medication orders for varenicline, bupropion and nicotine replacement therapy; (2) a fax automatically sent to the patient's primary care provider, informing him/her of the initiation of tobacco treatment (3 an electronic fax sent to the state smokers' quitline (QL) for post-discharge treatment (4) a prompt at discharge encouraging prescription of outpatient pharmacotherapy, and (5) a set of 5 or more QL-initiated counseling calls to subjects for 2 months post-discharge. Prior to study initiation, internal medicine and emergency medicine housestaff and hospitalists will be trained in tobacco treatment. ITOS will be activated, and will cover all inpatient units. Outcome measures include biochemically confirmed tobacco abstinence and an economic analysis. Follow-up will be done at 1, 6, and 12 months. The primary aim of this project is to determine whether ITOS+AD compared to AD improves 12-month smoking cessation in 960 smokers age > 18 years admitted to YNHH. Secondary aims are to 1) evaluate ITOS's ability to encourage smokers to engage in treatment; 2) assess ITOS's ability to enhance inpatient treatment of smoking; and 3) conduct an economic analysis of the intervention. Study findings and a toolkit will be disseminated through various professional societies and organizations. The study team consists of an outstanding group of investigators with rich experience in tobacco treatment, provider training, implementation science, and HIT. PUBLIC HEALTH RELEVANCE: Millions of smokers are admitted each year to US hospitals. These admissions may be a good time to begin treating tobacco dependence. This study will evaluate whether an electronic order set can improve the treatment of hospitalized smokers, and reduce their prevalence of smoking.

描述（由申请人提供）：美国有 4600 万吸烟者，每年导致 6-1200 万人住院。这些承认为烟草控制提供了一个受教的时刻。电子病历 (EMR) 等健康信息技术 (HIT) 的进步为住院吸烟者实施循证、经济高效、可持续的烟草治疗计划提供了机会。该提案的总体目标是研究嵌入 EMR 中的新型综合烟草订单集 (ITOS) 在促进成年住院患者持续戒烟方面的有效性。我们建议在耶鲁纽黑文医院 (YNHH) 进行一项由提供者随机提供的 ITOS + 学术细节 (AD) 与单独 AD 进行比较的 2 臂试验。 AD 组的医生收治的受试者可能会收到戒烟手册和电子订购的药物，这是我们的护理标准。 ITOS 部门的提供者将访问电子订单集，其中包括：(1) 伐尼克兰、安非他酮和尼古丁替代疗法的药物订单； (2) 自动发送给患者初级保健提供者的传真，通知他/她开始烟草治疗（3 发送至州吸烟者戒烟热线 (QL) 进行出院后治疗的电子传真 (4) 提示出院时鼓励门诊药物治疗处方，以及 (5) 在出院后 2 个月内对受试者进行 5 次或更多 QL 发起的咨询电话，在研究开始之前，内科和急诊科的工作人员和住院医生将接受烟草方面的培训。 ITOS 将启动，并将涵盖所有住院病房的结果测量，包括在第 1、6 和 12 个月进行的经济分析。与 AD 相比，ITOS+AD 是否能改善 YNHH 入院的 960 名年龄 > 18 岁吸烟者的 12 个月戒烟情况次要目标是 1) 评估 ITOS 鼓励吸烟者参与的能力。治疗中； 2) 评估 ITOS 加强住院患者吸烟治疗的能力； 3) 对干预措施进行经济分析。研究结果和工具包将通过各个专业协会和组织传播。研究团队由一群优秀的研究人员组成，他们在烟草治疗、提供者培训、实施科学和 HIT 方面拥有丰富的经验。公共卫生相关性：每年有数百万吸烟者被送往美国医院。这些承认可能是开始治疗烟草依赖的好时机。这项研究将评估电子医嘱集是否可以改善住院吸烟者的治疗，并降低他们的吸烟率。