Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART).
Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART).
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DOI：
10.1186/s12971-015-0056-5
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发表时间：
2015
影响因子：
3.7
通讯作者：
Consortium of Hospitals Advancing Research on Tobacco (CHART)
中科院分区：
文献类型：
--
作者：
Duffy SA;Cummins SE;Fellows JL;Harrington KF;Kirby C;Rogers E;Scheuermann TS;Tindle HA;Waltje AH;Consortium of Hospitals Advancing Research on Tobacco (CHART)
本文描述了美国国立卫生研究院支持的七个医院推进烟草研究联盟 (CHART) 研究中的保真度监测（治疗差异化、培训、实施、接收和制定）。该研究的目的是描述监测保真度的方法，包括治疗差异化（缺乏交叉）、提供者培训、提供者提供治疗、患者接受治疗和患者表现（行为），并提供这些原则的应用示例。 CHART 研究于 2010 年至 2014 年间进行，总共招募了超过 9500 名住院吸烟者，测试了不同的戒烟干预措施（咨询、药物和随访电话），这些干预措施在 Cochrane 协作评价中被证明是有效的。 CHART 研究将其独特的治疗组与常规护理进行了比较，在基线和 6 个月的随访中使用了共同的核心措施，但监测干预措施实施的保真度的方法有所不同。治疗差异化策略包括使用准实验设计以及对干预组和对照组的监测。几乎所有研究都对人员进行了广泛的培训，并使用清单来监测干预措施，但这些清单上的项目差异很大，并且基于干预措施的独特方面、美国公共卫生服务和联合委员会戒烟标准或顾问融洽关系。所有研究中药物的发放率从 31% 到 100% 不等，其中免费药物发放的研究水平较高，而寻求在现实世界系统中为患者获取处方的研究则较低。在使用自动化（交互式语音应答和网站）系统的研究中，治疗提供率最高，但这并不能自动转化为治疗接受和实施。一些研究以两种方式衡量治疗实施情况（例如，咨询师或自动系统报告与患者报告），显示两种措施之间的一致或不一致。虽然保真度监测可能具有挑战性，尤其是在传播试验中，但七项 CHART 研究使用了多种方法来提高保真度，同时考虑了可行性和可持续性。向住院吸烟者传播烟草策略。临床试验注册号NCT01309217。住院吸烟者戒烟。临床试验注册号NCT01289275。使用“温暖交接”将住院吸烟者与出院后的烟草治疗联系起来：随机对照试验的研究方案。临床试验注册号NCT01305928。基于网络的戒烟干预，从住院患者过渡到门诊患者。临床试验注册号NCT01277250。城市医院患者戒烟干预措施的有效性。临床试验注册号NCT01363245。住院吸烟者出院后干预措施的比较效果。临床试验注册号NCT01177176。将两家大型医院住院吸烟者的床边和门诊戒烟服务联系起来对健康和经济的影响。临床试验注册号NCT01236079。
This paper describes fidelity monitoring (treatment differentiation, training, delivery, receipt and enactment) across the seven National Institutes of Health-supported Consortium of Hospitals Advancing Research on Tobacco (CHART) studies. The objectives of the study were to describe approaches to monitoring fidelity including treatment differentiation (lack of crossover), provider training, provider delivery of treatment, patient receipt of treatment, and patient enactment (behavior) and provide examples of application of these principles. Conducted between 2010 and 2014 and collectively enrolling over 9500 inpatient cigarette smokers, the CHART studies tested different smoking cessation interventions (counseling, medications, and follow-up calls) shown to be efficacious in Cochrane Collaborative Reviews. The CHART studies compared their unique treatment arm(s) to usual care, used common core measures at baseline and 6-month follow-up, but varied in their approaches to monitoring the fidelity with which the interventions were implemented. Treatment differentiation strategies included the use of a quasi-experimental design and monitoring of both the intervention and control group. Almost all of the studies had extensive training for personnel and used a checklist to monitor the intervention components, but the items on these checklists varied widely and were based on unique aspects of the interventions, US Public Health Service and Joint Commission smoking cessation standards, or counselor rapport. Delivery of medications ranged from 31 to 100 % across the studies, with higher levels from studies that gave away free medications and lower levels from studies that sought to obtain prescriptions for the patient in real world systems. Treatment delivery was highest among those studies that used automated (interactive voice response and website) systems, but this did not automatically translate into treatment receipt and enactment. Some studies measured treatment enactment in two ways (e.g., counselor or automated system report versus patient report) showing concurrence or discordance between the two measures. While fidelity monitoring can be challenging especially in dissemination trials, the seven CHART studies used a variety of methods to enhance fidelity with consideration for feasibility and sustainability. Dissemination of Tobacco Tactics for hospitalized smokers. Clinical Trials Registration No. NCT01309217. Smoking cessation in hospitalized smokers. Clinical Trials Registration No. NCT01289275. Using “warm handoffs” to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Clinical Trials Registration No. NCT01305928. Web-based smoking cessation intervention that transitions from inpatient to outpatient. Clinical Trials Registration No. NCT01277250. Effectiveness of smoking-cessation interventions for urban hospital patients. Clinical Trials Registration No. NCT01363245. Comparative effectiveness of post-discharge interventions for hospitalized smokers. Clinical Trials Registration No. NCT01177176. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals. Clinical Trials Registration No. NCT01236079.