Testing the association of 5A smoking advice patterns with novel patient outcomes

测试 5A 吸烟建议模式与新患者结果的关联

• 批准号: 8637438
• 负责人: SUSAN A. FLOCKE
• 金额: $ 7.93万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8637438
• 关键词: Abstinence; Address; Adult; Area; Behavior; Cigarette; Clinical; Clinical Practice Guideline; Code; Communities; Counseling; Data Collection; Dependence; Disadvantaged; Educational Intervention; Effectiveness; Elements; Goals; Gold; Guidelines; Health Professional; Intervention; Lead; Measurement; Measures; Medical Records; Meta-Analysis; Methods; Modeling; Morbidity - disease rate; Outcome; Outcome Measure; Patient observation; Patients; Pattern; Performance; Population; Positioning Attribute; Primary Health Care; Readiness; Reporting; Research; Research Personnel; Resources; Sample Size; Sampling; Scheme; Smoke; Smoking; Smoking Cessation Intervention; Staging; Surveys; System; Testing; Time; Tobacco; Tobacco use; Training; United States; United States Dept. of Health and Human Services; Visit; Withholding Treatment; Work; Workplace; base; behavior change; brief advice; cost; design; improved; innovation; mortality; multilevel analysis; novel; premature; primary care setting; public health relevance; smoking cessation; smoking prevalence; systematic review; tool

DESCRIPTION (provided by applicant): Tobacco use continues to be one of the leading, preventable causes of morbidity and morbidity in the United States and primary care clinicians are in a unique position to provide brief advice to a large portion of the population. The 5As framework (ASK, ADVISE, ASSESS, ASSIST, ARRANGE) is recommended for brief smoking cessation counseling in the primary care context. Systematic reviews indicate a moderate positive association between counseling based on the 5As and abstinence from smoking; however most 5A assessments rely on clinician recall, patient recall or medical record review that may lead to over or under-reporting of actual clinician behavior. Further, there is little dat to elucidate the effect of the completeness and appropriate sequence of delivery of the 5As on patient outcomes. Accurately measuring the impact of low intensity interventions, like brief clinician advice based on the 5As framework, requires a patient outcome measure that is reliable, sensitive to change, applicable to the full spectrum of patient level of readiness for smoking cessation and associated with smoking abstinence. Our study team has developed two innovative measures to address these methodologic challenges. First, we developed the 5As Direct Observation Coding scheme (5A-DOC) that uses clinician-patient talk to determine the degree to which each of the 'A's are accomplished. The 5A-DOC is reliable, valid and advice can be classified with regard to completeness and appropriate sequencing of delivery of the 'A's. Second, using Rasch analysis we developed an innovative measure of Incremental Behavior Change for smoking cessation (IBC- S).This measure is reliable, sensitive to change and associated with smoking cessation. By pooling data from the initial sample of 131 cases used to develop the 5A-DOC with a new study, we can apply the 5A-DOC to 774 cases across 59 primary care clinicians and test associations with smoking cessation-related outcomes using multilevel modeling with adequate power. Patient outcomes, including the IBC-S, are parallel across both studies. A subsample of patients in Study 2 completed a survey assessing receipt of each 5A element such that we can compare patient report to the 5A-DOC. We have a compelling opportunity to examine the following research questions: What is the effect of complete delivery of the 5A elements on intermediate patient outcomes (i.e. patient recall of the advice, incremental behavior change, reduction in the number of cigarettes, and reported smoking cessation)? What is the effect of the sequence of delivery of the 5A elements on intermediate patient outcomes? How accurate are patient reports of the 5A elements compared to a direct observation coding system? This work is important to researchers assessing the 5As, educators of clinicians and ultimately can impact the efficiency and effectiveness of cessation advice in the primary care setting.

描述（由申请人提供）：烟草的使用仍然是美国的主要，可预防的发病率和发病率的原因之一，而初级保健临床医生处于独特的位置，可以向大部分人口提供简短的建议。建议在初级保健环境中进行简短的戒烟咨询（询问，建议，评估，协助，安排）。系统评价表明，基于5A的咨询与戒烟之间的咨询之间存在一个中等的积极联系；但是，大多数5A评估都取决于临床医生的召回，患者召回或病历审查，这可能导致实际临床医生行为的报告或不足。此外，几乎没有DAT可以阐明5A的完整性和适当分娩顺序对患者预后的影响。准确地测量低强度干预措施的影响，例如基于5AS框架的简短临床医生建议，需要一种可靠的患者结局指标，可靠，对变化敏感，适用于患者戒烟的全方位准备水平，并与吸烟戒烟相关。我们的研究团队已经制定了两项创新措施，以应对这些方法论挑战。首先，我们开发了5A直接观察编码方案（5A-DOC），该编码方案使用临床医生讲话来确定每个“ A”的完成程度。 5A-DOC可靠，有效，并且可以将建议分类为“完整性和适当的“ A”交付的测序。其次，使用Rasch分析，我们开发了一种创新的量度，以进行戒烟（IBC-S）的增量行为变化。此措施是可靠的，对变化敏感并与戒烟有关。通过从131例使用新研究开发5A-DOC的病例的初始样本中汇总数据，我们可以在59名初级保健临床医生中将5A-DOC应用于774例病例，并使用具有足够功能的多级建模进行测试与戒烟相关结果的关联。在两项研究中，包括IBC-S在内的患者结局（包括IBC-S）都是平行的。研究2中的患者子样本完成了评估每个5A元素收到的调查，因此我们可以将患者报告与5A-DOC进行比较。我们有一个令人信服的机会来研究以下研究问题：完全递送5A元素对中级患者结局的影响是什么（即患者对建议的召回，逐步行为变化，减少香烟的数量以及报告的戒烟）有何影响？ 5A元素传递顺序对中间患者结局的影响是什么？与直接观察编码系统相比，患者的5A元素报告的准确性如何？这项工作对于评估5AS，临床医生的教育者的研究人员很重要，最终可能会影响戒烟建议在初级保健环境中的效率和有效性。