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：
8508467
负责人：
NANCY A RIGOTTI
金额：
$ 43.28万
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 2013-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8508467
关键词：
Acute Adherence Admission activity Adopted Adoption Adult Aftercare Automation Bupropion Caring Cause of Death Cotinine Counseling Diagnosis Effectiveness Effectiveness of Interventions Enrollment FDA approved General Hospitals Guidelines Health Health system Healthcare Hospital Mortality Hospitals Individual Intervention Joints Life Life Expectancy Link Long-Term Care Massachusetts Measures Medicare Meta-Analysis Modeling Outcome Outcome Measure Outcome Study Patients Pennsylvania Pharmaceutical Preparations Pharmacotherapy Population Prevalence Principal Investigator Professional counselor Provider Randomized Relapse Research Design Risk Services Site Smoker Smoking Smoking Cessation Intervention Subgroup System Telephone Testing Tobacco Tobacco Dependence Tobacco use Translating Translations Triage United States Public Health Service Voice Withholding Treatment Work cigarette smoking clinical practice comparative effectiveness cost cost effective cost effectiveness effective intervention effective therapy effectiveness trial efficacy research efficacy trial evidence base experience follow-up health care service utilization hospital readmission innovation interest intervention effect medication compliance meetings mortality nicotine replacement novel policy implication primary outcome programs quitline response smoking cessation smoking intervention standard care tobacco abstinence uptake varenicline

项目摘要

DESCRIPTION (provided by applicant): Cigarette smoking is the leading preventable cause of death in the U.S. The 2008 US 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 >1 month after discharge. The challenge is to translate this efficacy from research into clinical practice by identifying an evidence-based cost-effective model that U.S. hospitals can adopt. The major barrier is sustaining contact after discharge. This project tests an innovative strategy to efficiently sustain patient contact after discharge by streamlining the delivery of post- discharge smoking interventions in order to maximize their uptake. Specific Aim: To test the effectiveness of an innovative strategy to increase hospitalized smokers' long-term tobacco abstinence rate by maximizing their use of evidence-based tobacco treatment (counseling and medication) after hospital discharge. Study Design: A multi-site randomized controlled comparative effectiveness trial will enroll 1350 adult smokers admitted to 3 acute care hospitals in Massachusetts and Pennsylvania. All subjects will receive a brief in-hospital smoking intervention and be randomly assigned at discharge to either Standard Care (referral to the MA or PA state quitline) or Extended Care, consisting of a 3-month program with 2 components: (1) Free Medication: A 30- day supply of FDA-approved medication (nicotine replacement, bupropion, or varenicline) given at hospital discharge and refillable free for a total of 90 days to facilitate medication use and adherence; (2) Interactive Voice Response (IVR) Triage to Telephone Counseling from a national quitline provider (Free & Clear). IVR is proactive. It aims to encourage medication adherence and enhance counseling efficiency by identifying smokers who need post-discharge support. Immediate transfer of a patient from automated IVR call to a live telephone counselor will facilitate a successful connection to counseling. Using a national quitline provider offers efficient scaling. Outcomes, assessed at 1, 3, and 12 months after hospital discharge, are: (1) intervention effectiveness (cotinine-validated 7-day point-prevalence tobacco abstinence rate at 12 month follow-up [1o outcome] and other measures of tobacco abstinence); (2) smoking cessation treatment utilization, and (3) cost-effectiveness (cost per quit). An exploratory analysis will examine the intervention's effect on health and health care utilization (hospital readmission and mortality in the 12 months after discharge). Policy implication: Standard Care meets current Medicare and Joint Commission National Hospital Quality Measures (NHQM) for tobacco. Extended Care meets the revised tobacco NHQM that are being reviewed for adoption. This trial of Extended Care will provide strong evidence about the proposed hospital quality measure revisions and could offer U.S. hospitals an evidence-based way to comply with them.

描述（由申请人提供）：吸烟是美国主要的可预防死亡原因。2008 年美国公共卫生服务戒烟指南建议在所有医疗保健机构（包括医院）中向吸烟者提供有效的治疗，包括药物治疗和咨询。每年有近 400 万吸烟者住院，入院为干预提供了一个“受教时刻”。院内戒烟干预是有效的，但前提是出院后接触持续> 1 个月。面临的挑战是通过确定美国医院可以采用的基于证据的成本效益模型，将这种功效从研究转化为临床实践。主要障碍是放电后的持续接触。该项目测试了一种创新策略，通过简化出院后吸烟干预措施的实施，以最大限度地提高其采用率，从而有效地维持出院后患者的接触。具体目标：测试创新策略的有效性，该策略通过在出院后最大限度地使用循证烟草治疗（咨询和药物）来提高住院吸烟者的长期戒烟率。研究设计：一项多中心随机对照有效性比较试验将招募马萨诸塞州和宾夕法尼亚州 3 家急症护理医院收治的 1350 名成年吸烟者。所有受试者将接受简短的院内吸烟干预，并在出院时被随机分配至标准护理（转介至马萨诸塞州或宾夕法尼亚州戒烟热线）或延伸护理，该护理由为期 3 个月的计划组成，包含 2 个组成部分：(1) 免费药物：出院时提供 30 天 FDA 批准的药物（尼古丁替代品、安非他酮或伐尼克兰），并可免费补充总共 90 天，以促进药物使用和依从性； (2) 交互式语音应答 (IVR) 分类到国家戒烟热线提供商提供的电话咨询（免费且清晰）。 IVR 是主动的。它旨在通过识别需要出院后支持的吸烟者来鼓励药物依从性并提高咨询效率。将患者从自动 IVR 呼叫立即转移到现场电话咨询师将有助于成功连接咨询。使用国家戒烟热线提供商可以提供有效的扩展。出院后 1、3 和 12 个月评估的结果为：(1) 干预效果（可替宁验证的 7 天点患病率，12 个月随访时的戒烟率 [1o 结果]和其他烟草测量指标）节制）; (2) 戒烟治疗的利用，以及 (3) 成本效益（每次戒烟的成本）。探索性分析将检查干预措施对健康和医疗保健利用的影响（出院后 12 个月内的再入院和死亡率）。政策含义：标准护理符合现行医疗保险和联合委员会国家医院烟草质量措施 (NHQM)。延伸护理符合正在审查通过的修订后的烟草 NHQM。此次延伸护理试验将为拟议的医院质量衡量标准修订提供强有力的证据，并可为美国医院提供一种以证据为基础的方式来遵守这些标准。