CONNECT: COmpreheNsive traiNing and Engagement in Cessation Treatment

点击翻译按钮获取中文摘要

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.