Smoking Interventions for Hospital Patients:A Comparative Effectiveness Trial

针对医院患者的吸烟干预措施：比较有效性试验

基本信息

批准号：
7816491
负责人：
NANCY A RIGOTTI
金额：
$ 49.96万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-30 至 2011-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7816491
关键词：
Abstinence Address Adherence Admission activity Adopted Adult Ambulatory Care Area Beds Boston Bupropion Cardiovascular Diseases Caring Cause of Death Chronic Obstructive Airway Disease Clinical Research Cost Effectiveness Analysis Cotinine Counseling Disease Enrollment Ensure FDA approved General Hospitals Grant Guidelines Health Healthcare Hospitals Inpatients Intervention Intervention Studies Joint Commission on Accreditation of Healthcare Organizations Leadership Massachusetts Measures Medicare Medication Management Modeling Outcome Patient Discharge Patients Pharmaceutical Preparations Pharmacotherapy Pneumonia Population Prevalence Principal Investigator Professional counselor Proxy Randomized Randomized Controlled Trials Reporting Research Research Infrastructure Risk Saliva Sampling Smoke Smoker Smoking Smoking Cessation Intervention Surveys Teaching Hospitals Technology Telephone Testing Time Tobacco Translating Treatment Efficacy United States Public Health Service Upper arm Withholding Treatment abstracting base cigarette smoking clinical practice comparative effectiveness cost cost effectiveness effective intervention effective therapy effectiveness trial efficacy research evidence base follow-up high risk improved innovation meetings mortality nicotine replacement primary outcome programs smoking cessation smoking intervention standard care tobacco abstinence treatment as usual varenicline voice recognition

项目摘要

DESCRIPTION (provided by applicant): Smoking Interventions for Hospital Patients: A Comparative Effectiveness Trial Project Summary/Abstract The Challenge: This application addresses broad Challenge Area (04), Clinical Research, and specific Challenge Topic, 04-HL-116: Cost-effective strategies to achieve smoking cessation in hospitalized patients with cardiovascular disease and COPD. Cigarette smoking is the leading preventable cause of death in the U.S. The 2008 U.S. Public Health Service Smoking Cessation Guideline recommends offering effective treatment to smokers in every health care setting. A hospital admission provides an opportunity for a smoker to quit. Smoking cessation counseling provided in the hospital is effective, but only if it continues for >1 month after discharge. Smoking cessation medications add benefit to counseling but are not often used. The current challenge is to translate this efficacy research into routine clinical practice. The major barrier is to make the transition from inpatient to outpatient care. National Hospital Quality Measures (NHQM) now report whether a tobacco intervention is provided to hospitalized smokers with CVD, COPD, or pneumonia, but the necessary post-discharge contact is not required. An evidence-based, cost-effective intervention model that can be adopted by U.S. hospitals is needed to realize the potential impact of hospital smoking interventions. Research Plan: The Specific Aim is to conduct a randomized controlled comparative effectiveness trial of two strategies to promote smoking cessation in hospitalized patients: (1) a hospital-only intervention that meets NHQM quality standards ("Standard Care"), and (2) an "Enhanced Care" model that will facilitate the sustained use of smoking counseling and medication after discharge to produce long-term abstinence. It will include 3 months of telephone counseling after discharge and feature 2 innovations. First, to increase medication use, smokers willing to make a quit attempt will receive a free 30-day sample of their choice of FDA-approved smoking cessation medication at hospital discharge. Second, to increase counseling cost-effectiveness, we will use interactive voice recognition (IVR) technology. It will make automated telephone calls to identify the smokers most likely to benefit from continued counseling after discharge. The trial will enroll 330 adult smokers admitted to Massachusetts General Hospital, a 900-bed teaching hospital. Outcomes will be measured 1 and 6 months after hospital discharge. Study hypotheses are that the enhanced care arm, compared to usual care, is feasible and will increase (1) the use of smoking cessation treatment after discharge, (2) the duration of post-discharge tobacco abstinence, and (3) validated tobacco abstinence 6 months after hospital discharge (primary outcome). The cost-effectiveness (cost per quit) of the interventions will be also be compared. Potential Impact: Nearly 4 million U.S. smokers are hospitalized each year, many of them at high risk for tobacco-related mortality due to CVD or COPD. This project could identify a way to translate an effective smoking cessation intervention into routine hospital practice and thereby increase the reach and impact of tobacco treatment. It could also provide evidence to support a revised NHQM hospital quality measure. Project Relevance Cigarette smoking is the leading preventable cause of death in the U.S. Smoking cessation reduces health risks. Being hospitalized provides a smoker a good opportunity to quit smoking. This project will test two strategies for providing assistance, using both smoking cessation counseling and pharmacotherapy, to help hospitalized smokers stop smoking after hospital discharge.

描述（由申请人提供）：医院患者的吸烟干预措施：比较有效性试验项目摘要/摘要挑战：该应用程序解决了广泛的挑战领域 (04)、临床研究和特定的挑战主题，04-HL-116：成本-心血管疾病和慢性阻塞性肺病住院患者实现戒烟的有效策略。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每个医疗机构为吸烟者提供有效的治疗。入院为吸烟者提供了戒烟的机会。医院提供的戒烟咨询是有效的，但前提是出院后持续> 1 个月。戒烟药物可以增加咨询的效果，但并不经常使用。当前的挑战是将这项功效研究转化为常规临床实践。主要障碍是从住院治疗过渡到门诊治疗。国家医院质量措施 (NHQM) 现在报告是否向患有 CVD、COPD 或肺炎的住院吸烟者提供烟草干预，但不需要必要的出院后接触。美国医院需要一种可以采用的基于证据的、具有成本效益的干预模式，以实现医院吸烟干预措施的潜在影响。研究计划：具体目标是对两种促进住院患者戒烟的策略进行随机对照比较有效性试验：(1) 符合 NHQM 质量标准（“标准护理”）的仅限医院的干预措施，以及 (2) “加强护理”模式将促进出院后持续使用吸烟咨询和药物以实现长期戒烟。它将包括出院后 3 个月的电话咨询和 2 项创新。首先，为了增加药物使用，愿意尝试戒烟的吸烟者将在出院时收到一份为期 30 天的免费样品，其中包含他们选择的 FDA 批准的戒烟药物。其次，为了提高咨询成本效益，我们将使用交互式语音识别（IVR）技术。它将拨打自动电话来识别最有可能从出院后继续咨询中受益的吸烟者。该试验将招募马萨诸塞州总医院收治的 330 名成年吸烟者，该医院是一家拥有 900 个床位的教学医院。结果将在出院后 1 个月和 6 个月进行测量。研究假设是，与常规护理相比，强化护理组是可行的，并且会增加（1）出院后戒烟治疗的使用，（2）出院后戒烟的持续时间，以及（3）经过验证的戒烟出院后 6 个月（主要结果）。还将比较干预措施的成本效益（每次戒烟成本）。潜在影响：每年有近 400 万美国吸烟者住院，其中许多人因 CVD 或 COPD 而面临与烟草相关的死亡的高风险。该项目可以找到一种方法，将有效的戒烟干预措施转化为医院的日常实践，从而扩大烟草治疗的范围和影响。它还可以提供证据支持修订后的 NHQM 医院质量衡量标准。项目相关性吸烟是美国主要的可预防死亡原因。戒烟可降低健康风险。住院为吸烟者提供了戒烟的好机会。该项目将测试两种提供援助的策略，即使用戒烟咨询和药物疗法，帮助住院吸烟者出院后戒烟。