CONNECT: COmpreheNsive traiNing and Engagement in Cessation Treatment

连接：戒烟治疗的综合培训和参与

• 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
• 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

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.

项目总结 美国成人吸烟率在全国范围内约为14%，但差异很大 持续存在，包括在家庭年收入为35,000美元(21.3%)的成年人中，接受医疗补助的人 (23.9%)，未参保者(23.9%)。这些人群接受戒烟的可能性也较小。 并使用循证戒烟干预措施。许多公共卫生议程强调 解决这些不平等现象，以减少与吸烟有关的发病率和死亡率。要做到这一点，我们需要 增加这些人群获得戒烟服务的机会。社区卫生中心(CHC)是 为2900万社会经济弱势吸烟者提供护理的理想环境 患者，其中大多数人没有保险或公共保险。将Quitline推荐整合到这些 Setting有可能接触到大量的吸烟者。双向电子推荐系统，允许 提供者将转介从电子健康记录(EHR)直接发送到Quitline，并将Quitline退出到 将有关患者的处置信息发送回患者的个人电子病历，为 更高效、更规范的转介制度。与传真相比，此方法增加了Quitline覆盖范围 或间接转介方法；然而，疾病控制和预防中心的目标是戒烟 每年有8%的烟草使用者没有得到满足。关键的知识缺口存在于如何最好地 在医疗保健环境中实施Quitline电子转介系统，以最大限度地提高 戒烟服务。加强学术细节，包括教育外展和绩效审计 和反馈，可以增加最佳做法的使用和采用新的流程和程序，其中 医疗保健提供者；然而，面对面和持续增强的学术细节很少用于 Quitline推荐实施。美国几乎一半的州报告称，没有与供应商相关的员工培训 推荐计划。这项整群随机试验将招募30名俄勒冈州CHC(n~15,000名吸烟者)。 一半的诊所将随机接受Quitline电子转介系统，并增强学术研究 详细说明(干预条件；n=15家诊所)和一半接受Quitline电子转介系统，而不是 增强学术细节(对照条件；n=15个诊所)。这项务实的试验将使用EHR和 Quitline数据用于评估患者的戒烟辅助覆盖率和有效性 比较干预诊所与对照诊所患者的就诊率。我们还将评估 电子推荐系统的成本效益，包括增强的学术细节和不增强的学术细节。这是可扩展的 干预措施有很高的潜力通过以下方式增加戒烟治疗的可及性 国家戒烟热线和为大量社会经济弱势群体提供服务的社区卫生保健机构之间的合作 吸烟者。这项研究涉及国家癌症研究所的研究重点，即开发有针对性的和 可扩展的干预措施，以减少这一脆弱人群中的吸烟。