PROJECT 2

项目2

• 批准号: 10661348
• 负责人: Alicia K Matthews
• 金额: $ 50.33万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-31 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10661348
• 关键词: Address; Adult; Awareness; Behavioral; Cancer Control; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Clinical Trials Design; Counseling; Education; Educational Materials; Electronic Health Record; Enrollment; Family health status; Federally Qualified Health Center; Future; Goals; Health; Healthcare; Height; Individual; Infrastructure; Intake; Link; Low Income Population; Low income; Malignant Neoplasms; Measures; Methods; Mission; Neighborhoods; New York; Participant; Patient Education; Patients; Pattern; Persons; Pharmacotherapy; Population; Population Intervention; Poverty; Poverty Areas; Professional counselor; Provider; Randomized; Recommendation; Reporting; Risk Factors; Screening for cancer; Self Determination; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Tobacco; Tobacco Use Cessation; Tobacco use; Uninsured; Vulnerable Populations; active control group; arm; compare effectiveness; cost; effectiveness evaluation; health care delivery; health disparity; health inequalities; health information technology; implementation evaluation; implementation strategy; improved; innovation; modifiable risk; nicotine patch; novel strategies; outreach; patient navigation; patient oriented; patient portal; population based; primary outcome; public health priorities; quitline; randomized trial; randomized, clinical trials; reduce tobacco use; safety net; screening; smoking cessation; smoking prevalence; social; social capital; telephone coaching; theories

Although smoking rates are declining, they remain elevated among individuals impacted by poverty (36%). Tobacco use remains an important modifiable risk factor for cancer and an urgent public health priority. Despite elevated smoking rates, low-income smokers have less awareness of, access to, and utilization of smoking cessation treatments. Federally Qualified Health Centers (FQHCs), safety-net care settings for the most vulnerable populations, represent an important yet under-appreciated opportunity for reducing smoking- related health inequalities. In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), received care at an FQHC. Innovation is needed to increase access to smoking cessation treatments among low-income smokers treated in FQHC practices serving PPA patients. Evidence shows that provider screening, counseling, and pharmacotherapy reduces tobacco use. However, consistent delivery of provider-led cessation treatments in clinical settings is challenging. State tobacco quitlines are effective, free or low-cost, and available in all states. Nevertheless, quitline usage is limited. The Centers for Disease Control recommends proactive strategies for increasing quitline use, including partnerships with health care centers. Electronic health record-linked patient portals are becoming a standard part of health care delivery and are a novel approach for proactively linking smokers to Quitlines. Evidence supports the reach and feasibility of portals for offering population-based interventions. However, prior studies have not tested implementation strategies for using portals to offer proactive linkage to quitlines. Informed by Social Determination Theory, Project 2 will evaluate the implementation of three scalable strategies, including (1) patient navigation, (2) widely available health information technology (HIT) infrastructure including the patient portal, for offering proactive linkage of low-income smokers and (3) the New York State Smoker's Quit Line (NYSSQL). We propose a population-based randomized trial in three FQHCs in SoCa neighborhoods. First, we will examine the effectiveness of an educational campaign paired with patient navigation for increasing patient portal enrollment (Aim 1). Next, we will evaluate the reach of the patient portal as an approach to delivering population-level advice to quit and smoking cessation treatment linkage (Aim 2). We will compare impact of referral type (opt-in referral vs. self-referral) on linkage to the NYSSQL (Aim 3). Aim 4 will compare the influence of message type (Arm 1 Choice vs. Arm 2 No-Choice in cessation goals) on rates of linkage to the NYSSQL and receipt of smoking cessation treatment. This project aligns with the SoCa mission of addressing health disparities in persistent poverty areas by improving health through tobacco cessation and overall portal health enrollment for future cancer screening outreach and cancer control measures.

尽管吸烟率正在下降，但受贫困影响的个人吸烟率仍然很高（36%）。 烟草使用仍然是癌症的一个重要的可改变危险因素，也是一个紧迫的公共卫生优先事项。 尽管吸烟率上升，但低收入吸烟者对吸烟的认识、获取和利用较少 戒烟治疗。联邦合格健康中心 (FQHC)、安全网护理机构 最弱势群体是减少吸烟的一个重要但未被充分认识的机会 相关的健康不平等。 2012 年，有 2100 万患者，其中大多数没有保险 (36%) 或没有保险 公共保险 (49%)，在 FQHC 接受护理。需要创新来增加吸烟的机会 在为 PPA 患者提供服务的 FQHC 实践中接受治疗的低收入吸烟者的戒烟治疗。 有证据表明，提供者筛查、咨询和药物治疗可以减少烟草使用。 然而，在临床环境中持续提供由医疗服务提供者主导的戒烟治疗具有挑战性。状态 烟草戒烟热线是有效的、免费或低成本的，并且在所有州都有提供。尽管如此，戒烟热线的使用 有限的。疾病控制中心建议采取积极主动的策略来增加戒烟热线的使用，包括 与医疗保健中心的伙伴关系。电子健康记录链接的患者门户正在成为标准 是医疗保健服务的一部分，是主动将吸烟者与戒烟热线联系起来的一种新颖方法。证据 支持提供基于人群的干预措施的门户网站的覆盖范围和可行性。然而，之前的研究 尚未测试使用门户网站提供主动戒烟热线链接的实施策略。 根据社会决定理论，项目 2 将评估三个可扩展的项目的实施情况 策略，包括 (1) 患者导航，(2) 广泛使用的健康信息技术 (HIT) 包括患者门户在内的基础设施，用于为低收入吸烟者提供主动联系；(3) 约克州吸烟者戒烟热线 (NYSSQL)。我们建议在三个 FQHC 中进行一项基于人群的随机试验 索卡社区。首先，我们将检查与患者配合的教育活动的有效性 用于增加患者门户注册的导航（目标 1）。接下来，我们将评估患者门户的覆盖范围 作为向人群提供戒烟建议和戒烟治疗联系的一种方法（目标 2）。 我们将比较引用类型（选择加入引用与自我引用）对 NYSSQL 链接的影响（目标 3）。目的 图 4 将比较消息类型（戒烟目标中的第 1 组选择与第 2 组无选择）对比率的影响 与 NYSSQL 的联系以及接受戒烟治疗的情况。该项目与 SoC 一致 通过烟草改善健康来解决持续贫困地区的健康差距的使命 戒烟和整体门户健康登记，用于未来的癌症筛查推广和癌症控制 措施。