ASSIST: Assessment of Medicaid policy on Smoking Cessation Assistance and Surgical Outcomes

ASSIST：评估有关戒烟援助和手术结果的医疗补助政策

• 批准号: 10797988
• 负责人: Steffani R Bailey
• 金额: $ 64.48万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-25 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10797988
• 关键词: Abstinence; Address; Adoption; Adult; Arthroscopy; Cardiovascular system; Cigarette; Data; Development; Disparity; Economically Deprived Population; Effectiveness; Electronic Health Record; Evaluation; Goals; Guidelines; Health; Health Personnel; Healthcare; Healthcare Systems; Hospitals; Insurance; Interview; Knee; Knowledge; Lead; Link; Medicaid; Methods; National Institute on Minority Health and Health Disparities; Neighborhood Health Center; Operative Surgical Procedures; Oregon; Orthopedic Surgery; Orthopedics; Outcome; Patients; Perception; Perioperative; Policies; Policy Maker; Population; Postoperative Period; Privatization; Protocols documentation; Quasi-experiment; Reduce health disparities; Reporting; Rotator Cuff; Smoking; Structure; Surgeon; Surgical complication; Surveys; Time; United States; Visit; Wound Infection; care coordination; design; experience; improved; innovation; interest; low socioeconomic status; medically necessary care; non-smoker; payment; primary care clinician; programs; repaired; smoking cessation; smoking prevalence; socioeconomic disadvantage; surgery outcome; surgical disparities; wound healing

PROJECT SUMMARY Smoking is associated with a variety of adverse health effects, including increased postoperative wound healing time, wound infections, and cardiovascular complications among surgery patients. The associations between pre-operative smoking cessation and improved surgical outcomes have led surgeons and hospitals to implement policies that require patients to quit smoking prior to elective surgeries. Given the high rate of smoking among socioeconomically disadvantaged populations and the even higher rate among Medicaid- insured surgery patients, these policies will disproportionately impact patients of lower socioeconomic status (SES). In 2017, Oregon implemented the first statewide policy in the United States that requires Medicaid- insured patients to quit smoking prior to a broad range of elective surgeries as a condition of payment for surgery by the state Medicaid program. This policy creates an opportune time to assist patients in quitting smoking pre-surgery (i.e., a “teachable moment”) and to support continued abstinence during post-operative visits; thus, this policy could result in higher rates of cessation assistance and cessation among patients of lower SES, potentially mitigating long-standing smoking-related disparities and providing support for implementation of similar policies among payers and health care systems. That said, some suggest that if patients do not receive cessation assistance and are denied surgery because they were unable to quit, these policies will exacerbate already existing smoking- and surgery-related disparities among those who are socioeconomically disadvantaged. The impact of these policies on smoking- and surgery-related outcomes among patients of lower SES are unknown. To address this knowledge gap, we will conduct a quasi- experimental study using a sequential mixed methods design. We will link electronic health record (EHR) data to Medicaid claims from 148 Oregon community health centers (CHCs) to examine changes in smoking- (cessation assistance and quit rates) and surgery- (rates of surgery and surgery complications) related outcomes among patients seeking elective orthopedic surgeries between 1/1/2014-12/31/2016 (pre-policy) and 1/1/2017-12/31/2019 (post-policy implementation). Informed by our quantitative analyses, we will conduct semi-structured interviews with health care leaders, primary care clinicians, orthopedic surgeons, and patients, and survey Care Coordination Organization leaders to explore organizational workflows and protocols related to this policy (e.g., increased cessation assistance), and perceptions and experiences of the policy on intended and unintended consequences. This innovative study will provide rigorous, actionable evidence to inform states and policy makers of the extent to which this policy results in the desired changes.

项目概要 吸烟与多种不良健康影响有关，包括术后伤口增加 手术患者的愈合时间、伤口感染和心血管并发症。 术前戒烟和改善手术结果之间的关系导致外科医生和医院 鉴于手术率较高，实施要求患者在择期手术前戒烟的政策。 社会经济弱势群体中的吸​​烟率更高，而医疗补助中的吸烟率甚至更高 对于有保险的手术患者，这些政策将对社会经济地位较低的患者产生不成比例的影响 (SES) 2017 年，俄勒冈州实施了美国第一项需要医疗补助的检察政策—— 投保患者在进行各种选择性手术之前戒烟，作为支付费用的条件 这项政策为帮助患者戒烟创造了时机。 术前吸烟（即“教育时刻”）并支持术后持续戒烟 因此，这项政策可能会导致患者的戒烟援助和戒烟率提高。 较低的社会经济地位，有可能缓解长期存在的与吸烟有关的差异，并为 尽管如此，一些人建议，如果支付者和医疗保健系统实施类似的政策。 患者没有接受戒烟援助，并且因为无法戒烟而被拒绝手术，这些 政策将加剧吸烟者和手术者之间已经存在的与吸烟和手术相关的差异 这些政策对吸烟和手术相关结果的影响。 为了解决这一知识差距，我们将进行一项准社会经济地位较低的患者的研究。 使用顺序混合方法设计的实验研究我们将链接电子健康记录（EHR）数据。 俄勒冈州 148 个社区健康中心 (CHC) 向医疗补助索赔申请，以检查吸烟情况的变化 （戒烟援助和戒烟率）和手术 - （手术率和手术并发症）相关 2014 年 1 月 1 日至 2016 年 12 月 31 日（政策前）和 2017年1月1日至2019年12月31日（政策实施后），我们将进行定量分析。 对医疗保健领导者、初级保健顾客、整形外科医生和患者进行半结构化访谈， 并对护理协调组织领导者进行调查，以探索相关的组织工作流程和协议 对该政策的看法（例如，增加戒烟援助），以及对该政策的看法和经验 这项创新研究将提供严格的、可操作的证据来提供信息。 国家和政策制定者认为这项政策能在多大程度上带来预期的变化。