CONNECT: COmpreheNsive traiNing and Engagement in Cessation Treatment

连接：戒烟治疗的综合培训和参与

基本信息

批准号：
10295696
负责人：
Steffani R Bailey
金额：
$ 66.03万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10295696
关键词：
Academic Detailing Address Adult Back Caring Centers for Disease Control and Prevention (U.S.)Clinic Cluster randomized trial Collaborations Communities Counseling Data Effectiveness Electronic Health Record Enrollment Ensure Feedback Goals Health Health Personnel Healthcare Household Hybrids Income Individual Inequality Intervention Knowledge Medicaid Methods Morbidity - disease rate National Cancer Institute Neighborhood Health Center Oregon Outcome Study Patient Self-Report Patients Performance Persons Pharmaceutical Preparations Physicians Population Primary Health Care Procedures Process Provider Public Health Randomized Randomized Controlled Trials Reporting Research Priority Services Smoke Smoker Smoking Smoking Cessation Intervention Standardization System Telefacsimile Tobacco Training Uninsured United States Vulnerable Populations base cost cost effective cost effectiveness cost-effectiveness evaluation design effectiveness evaluation evidence base experience health care settings health information technology implementation strategy improved incremental cost-effectiveness individual patient innovation mortality outreach participant enrollment patient oriented pragmatic trial primary care setting programs quitline recruit service utilization smoking cessation smoking prevalence socioeconomic disadvantage tobacco user treatment guidelines uptake

项目摘要

PROJECT SUMMARY Adult smoking prevalence in the United States (US) is approximately 14% nationwide, yet significant disparities persist, including among adults with annual household incomes <$35,000 (21.3%), Medicaid recipients (23.9%), and the uninsured (23.9%). These populations are also less likely to receive smoking cessation assistance and to use evidence-based cessation interventions. Many public health agendas emphasize addressing these inequalities to reduce smoking related morbidity and mortality. To do this, we need to increase accessibility to cessation services among these populations. Community health centers (CHCs) are ideal settings to reach smokers who are socioeconomically disadvantaged as they provide care to 29 million patients, the majority of whom are uninsured or publicly insured. Integrating Quitline referrals into these settings has the potential to reach a large number of smokers. Bidirectional eReferral systems, which allow providers to send a referral directly to the Quitline from the electronic health record (EHR) and Quitlines to send information about the patient's disposition back into the patient's individual EHR, provide a platform for more efficient and standardized referral systems. This method has increasedQuitline reach compared to faxed orindirect referral methods; however,the Centers for Disease Control and Prevention's goal for Quitlines to reach 8% of all tobacco users annually has not been met. A critical knowledge gap exists in how best to implement Quitline eReferral systems into health care settings to maximize the reach and effectiveness of cessation services. Enhanced academic detailing, which includes educational outreach and performance audit and feedback, can increase the use of best practices and the uptake of new processes and procedures among health care providers; however, in-person and ongoing enhanced academic detailing is infrequently used for Quitline referral implementation. Almost half of all US states report no staff training related to their provider referral programs. This cluster-randomized trial will recruit 30 Oregon CHCs (n~15,000 patients who smoke). Half of the clinics will be randomized to receive the Quitline eReferral system with enhanced academic detailing (intervention condition; n=15 clinics) and half to receive the Quitline eReferral system without enhanced academic detailing (comparison condition; n=15 clinics). This pragmatic trial will use EHR and Quitline data to assess rates of smoking cessation assistance reach and effectiveness among patients in the intervention clinics compared with rates among patients in the comparison clinics. We will also evaluate the cost-effectiveness of the eReferral system, both with and without enhanced academic detailing. This scalable intervention has high potential to increase accessibility to smoking cessation treatment through the collaboration between state Quitlines and CHCs that serve large numbers of socioeconomically disadvantaged smokers. This study addresses the National Cancer Institute's research priority of developing targeted and scalable interventions to reduce smoking among this vulnerable population.

项目摘要美国（美国）的成人吸烟患病率在全国范围内约为14％，但差异很大坚持不懈，包括年收入年收入的成年人，<$ 35,000（21.3％），医疗补助接收者（23.9％）和未投保的（23.9％）。这些人群也不太可能接受戒烟协助并使用基于证据的戒烟干预措施。许多公共卫生议程强调解决这些不平等，以减少与吸烟相关的发病率和死亡率。为此，我们需要增加这些人群中戒烟服务的可及性。社区卫生中心（CHC）是理想的环境可以吸引在社会经济上处于不利地位的吸烟者，因为他们为2900万患者，大多数没有保险或公开保险的患者。将Quitline推荐集成到这些设置有可能吸引大量吸烟者。双向外位系统，该系统允许提供者可以直接从电子健康记录（EHR）和Quitlines转介到Quitline 将有关患者处置的信息发送回患者的个人EHR，提供一个平台更有效，更标准化的推荐系统。与传真相比，此方法具有增加的标志线范围 Orindirect推荐方法；但是，疾病控制与预防中心的戒烟目标每年尚未满足所有烟草用户中的8％。重要的知识差距存在于如何最好的在医疗保健环境中实施戒烟线的偏爱系统，以最大程度地提高覆盖范围和有效性停止服务。增强的学术细节，包括教育外展和绩效审核和反馈，可以增加最佳实践的使用以及对新过程和程序的采用医疗保健提供者；但是，面对面和正在进行的增强的学术细节很少用于 Quitline推荐实现。美国几乎一半的州报告没有与其提供者有关的员工培训推荐程序。该集群随机试验将招募30名俄勒冈州CHC（吸烟的患者N〜15,000名患者）。一半的诊所将被随机分配以接受学术增强细节（干预条件； n = 15个诊所），一半以接收derefral系统增强的学术细节（比较条件； n = 15个诊所）。这项务实的审判将使用EHR和戒烟数据数据以评估戒烟援助的速度和患者之间的有效性干预诊所与比较诊所中患者的发生率相比。我们还将评估在有没有增强的学术细节的情况下，外毛体系的成本效益。这个可扩展干预具有很大的潜力，可以通过国家戒烟与CHC之间的合作，这些社会经济不利吸烟者。这项研究涉及国家癌症研究所的研究优先事项，即发展有针对性的和可扩展的干预措施，以减少这种脆弱人群中的吸烟。