Meaningful Use and Treatment of Smoking in Federally-Qualified Health Centers

在联邦合格的健康中心有意义地使用和治疗吸烟

基本信息

批准号：
9198217
负责人：
Steffani R Bailey
金额：
$ 17万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-02-15 至 2020-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9198217
关键词：
Address Adopted American Area Award Biometry Cause of Death Cessation Research Characteristics Clinic Clinical Clinical Practice Guideline Clinical Psychology Communities Congresses Counseling Data Development Doctor of Philosophy Effectiveness Electronic Health Record Eligibility Determination Environment Epidemiology Equation Family Practice Federally Qualified Health Center Future Goals Health Personnel Health Professional Health Sciences Hospitals Incentive Reimbursement Incentives Insurance Interview Knowledge Link Logistics Measurable Measures Medicaid Medical Medicare Mentors Methodology Methods Modeling National Institute of Drug Abuse Nicotine Dependence Office Visits Oregon Outcome Patients Peer Review Pharmaceutical Preparations Policies Policy Maker Preparation Prevention Research Primary Health Care Process Provider Public Health Publications Qualitative Methods Randomized Clinical Trials Readiness Recovery Regression Analysis Research Research Assistant Research Methodology Research Personnel Resources Services Smoking Smoking Cessation Intervention Smoking Status Statutes and Laws Structure Substance Abuse Detection Technology Testing Text Time Tobacco Dependence Tobacco use Training Training Activity Underserved Population United States United States Centers for Medicare and Medicaid Services Universities Withholding Treatment base brief advice career career development clinical practice craving design drug abuse prevention evidence based guidelines experience follow-up health disparity health information technology improved innovation member multidisciplinary patient population population based primary care setting professor programs public health relevance randomized trial skills smoking cessation standard of care willingness

项目摘要

DESCRIPTION (provided by applicant): Candidate: Dr. Steffani Bailey has her PhD in clinical psychology and is a Research Assistant Professor in the Department of Family Medicine at Oregon Health & Science University. Dr. Bailey has conducted lab-based studies on craving processes, and directed two randomized clinical trials for smoking cessation in community- based populations. She has 19 peer-reviewed publications, with 9 as first author. Dr. Bailey's previous research experience in smoking cessation, the training activities proposed in the K23 application, and her multidisciplinary team of mentors, will provide her with the expertise and guidance necessary to become an independent investigator in primary care smoking cessation research with underserved populations. Research Focus: Electronic health records (EHR) are increasingly being used to prompt health care providers to assess and treat tobacco use, as well as to document that these services were rendered. The United States Congress passed legislation ("meaningful use" of EHR) that could increase the use of the EHR for both assessing smoking status and providing cessation assistance in clinics serving Medicaid and Medicare patients. EHRs can aid in the ability to track the progress on selected indicators and can be utilized in research to identify important information about subpopulations that are less likely to be getting the standard of care for tobacco use treatment. Although research has shown that EHR use does increase the number of unique patients asked about smoking status, research is mixed on whether use of this technology increases rates of quitting advice or smoking cessation. The study will use quantitative data from OCHIN, a multiple-facility, linked EHR provider, and qualitative data from clinic observations and interviews with health care providers and patients. This mixed-methods study will 1) evaluate whether implementation of Stage 1 Meaningful Use of EHRs for smoking indicators, which includes changes to the EHR vital signs section, increases rates of assessing smoking status and readiness to quit, and smoking cessation assistance, 2) identify patient, provider, and clinic characteristics associated with rates of smoking assessment and delivery of cessation services, and 3) identify factors that promote and hinder smoking cessation treatment in primary care settings through clinic observations and interviews with both health care providers and patients. This research will inform the development of a primary care-based smoking cessation intervention that utilizes health information technology, as well as develop Dr. Bailey's career in primary care research focused on underserved populations. Training goals: Dr. Bailey's training goals include 1) developing an advanced understanding of facilitators and barriers to the assessment and treatment of smoking in federally-qualified health centers (FQHCs), including use of health information technology, 2) increasing her knowledge of health disparities in underserved populations, 3) developing skills in qualitative methodology and mixed methods research, including advanced biostatistical analysis. Environment: Dr. Bailey will undergo her career development in the Department of Family Medicine at Oregon Health & Science University, an organization with significant and longstanding resources for early-career researchers. She has strong institutional and departmental support. Methods: Using EHR data from 21 FQHC primary care clinics, and random effects Poisson regression, Dr. Bailey will evaluate whether implementation of Stage 1 Meaningful Use increases the rates of assessing smoking status and readiness to quit, and providing smoking cessation assistance (Aim 1). Using 2014 EHR data from 69 FQHC primary care clinics, she will conduct logistic generalized estimating equation regression analyses to examine associations between patient, provider, and clinic-level characteristics and rates of the assessment and treatment of smoking (Aim 2). Finally, using qualitative methods, she will identify facilitators and barriers to smoking cessation treatment in FQHCs. She will collect this data through patient and provider interviews and observations of clinics with the highest and lowest rates of smoking cessation assistance (Aim 3). Outcomes: These results will aid in determining whether resources being invested in the meaningful use of EHR are producing any measurable changes and how they might need to be improved. Findings from this study can inform policy and clinical practices, particularly in primary care settings that provide services to underserved populations with higher than average smoking rates. Results from this study will inform the design of a future intervention for smoking cessation in FQHCs that will be proposed in an R01 application during the latter years of the award period.

描述（由申请人提供）：候选人：Steffani Bailey 博士拥有临床心理学博士学位，是俄勒冈健康与科学大学家庭医学系的研究助理教授。贝利博士对烟瘾过程进行了实验室研究，并指导了两项针对社区人群戒烟的随机临床试验。她发表了 19 篇同行评审出版物，其中 9 篇为第一作者。 Bailey 博士之前在戒烟方面的研究经验、K23 申请中提出的培训活动以及她的多学科导师团队将为她提供成为服务不足人群的初级保健戒烟研究的独立研究者所需的专业知识和指导。研究重点：电子健康记录 (EHR) 越来越多地用于提示医疗保健提供者评估和治疗烟草使用，并记录提供这些服务的情况。美国国会通过了立法（电子病历的“有意义的使用”），可以增加电子病历的使用，以评估吸烟状况并在为医疗补助和医疗保险患者提供服务的诊所中提供戒烟援助。电子病历可以帮助跟踪选定指标的进展，并可用于研究以确定不太可能发生的亚人群的重要信息。获得烟草使用治疗的护理标准。尽管研究表明电子病历的使用确实增加了询问吸烟状况的独特患者的数量，但对于使用该技术是否会增加戒烟建议或戒烟率的研究结果不一。该研究将使用来自 OCHIN（一家多机构、互联的 EHR 提供商）的定量数据，以及来自临床观察和对医疗保健提供者和患者的访谈的定性数据。这项混合方法研究将 1) 评估是否实施第一阶段有意义地使用 EHR 来衡量吸烟指标，其中包括对 EHR 生命体征部分的更改、提高评估吸烟状况和戒烟准备的比率以及戒烟援助，2)确定与吸烟评估率和戒烟服务提供相关的患者、提供者和诊所特征，以及 3) 通过临床观察和对卫生保健提供者和戒烟服务提供者的访谈，确定促进和阻碍初级保健机构戒烟治疗的因素。患者。这项研究将为利用健康信息技术开发基于初级保健的戒烟干预措施提供信息，并发展贝利博士在针对服务不足人群的初级保健研究方面的职业生涯。培训目标：Bailey 博士的培训目标包括 1) 深入了解联邦合格健康中心 (FQHC) 吸烟评估和治疗的促进因素和障碍，包括使用健康信息技术，2) 增加她的健康知识服务不足人群的差异，3) 发展定性方法和混合方法研究的技能，包括先进的生物统计分析。环境：贝利博士将在俄勒冈健康与科学大学家庭医学系进行职业发展，该组织为早期职业研究人员提供了大量长期资源。她拥有强大的机构和部门支持。方法：使用来自 21 个 FQHC 初级保健诊所的 EHR 数据和随机效应泊松回归，Bailey 博士将评估实施第一阶段有意义的使用是否会提高评估吸烟状况和戒烟准备的比率，并提供戒烟援助（目标 1））。她将使用 69 个 FQHC 初级保健诊所的 2014 年 EHR 数据进行逻辑广义估计方程回归分析，以检查患者、提供者和诊所层面的特征以及吸烟评估和治疗率之间的关联（目标 2）。最后，她将使用定性方法确定 FQHC 戒烟治疗的促进因素和障碍。她将通过对患者和提供者的访谈以及对戒烟援助率最高和最低的诊所的观察来收集这些数据（目标 3）。结果：这些结果将有助于确定为有效使用电子病历而投入的资源是否正在产生任何可衡量的变化以及可能需要如何改进。这项研究的结果可以为政策和临床实践提供信息，特别是在为吸烟率高于平均水平的服务不足人群提供服务的初级保健机构中。这项研究的结果将为 FQHC 未来戒烟干预措施的设计提供信息，该干预措施将在奖励期的最后几年在 R01 申请中提出。