Do Practice Guidelines Reduce Smoking in Schizophrenia

描述：（申请人提供） 吸烟和尼古丁成瘾是严重的健康问题， 精神分裂症患者的吸烟率是普通人的两倍， 人口卫生保健研究和质量机构（AHRQ）最近 推广循证戒烟实践指南。AHRQ 报告总结了强有力的证据，表明这些做法的实施 对多个人群的临床影响。然而，它们还没有经过测试 在精神分裂症患者中。这项研究测试了实施 AHRQ关于医生提供的简短戒烟指南 对精神分裂症患者进行干预。我们假设 与在提供标准医疗服务的机构接受治疗的患者相比， 护理，参与者在实施这些AHRQ的机构接受治疗 指南将增加戒烟的尝试;增加戒烟的准备 戒烟;增加戒烟/禁欲;以及，减少 每天吸烟我们还假设，增加干预时间 而对指导方针的忠实将产生更好的结果。准实验 研究将比较接受与AHRQ实践一致的护理的患者 对接受与实践不一致的护理的患者的指导方针 指南马里兰州6个随机选择的精神健康门诊 将入组;随机分配3人实施指南 立即（实验条件），并将实施12 3个月，3个月将推迟执行准则 （控制条件），然后执行6个月的指南。评估 患者结果，随机选择的63名精神分裂症患者样本， 每个诊所（初始入组总数为378）将在三个时间点进行评估 点考虑到损耗，我们估计最终样本至少有50个 每个诊所的参与者（每个条件150人，总共300人）。 实践准则的实施将通过对下列人员的强化培训来实现： 研究中心的工作人员，持续监测和协助，并提供诊所 激励富达将通过图表审查进行密切监测， 参与者访谈该设计提出了分层数据结构，即， 个体患者被嵌套在医生内，并且医生被嵌套 在诊所内。因此，将利用多层次分析来解决 研究假设这种技术与传统的技术相比有许多优点。 多元回归（或ANCOVA）分析，包括检验假设的能力 关于跨水平效应（例如，如何实施AHRQ（医生一级 预测因子）影响患者水平的结果。它还容纳科目， 缺失数据，以及类内测量的非独立性（医生或 临床）或类内相关性。

DESCRIPTION: (provided by applicant) Cigarette smoking and nicotine addiction are significant health problems among people with schizophrenia, who smoke at double the rate of the general population. The Agency for Health Care Research and Quality (AHRQ) has recently promoted of evidenced-based practice guidelines for smoking cessation. The AHRQ report summarizes strong evidence that implementation of these practices has clinical impact across multiple populations. However, they have not been tested among persons with schizophrenia. This study tests the impact of implementing the AHRQ guidelines for brief, physician-delivered smoking cessation interventions among people with schizophrenia diagnoses. We hypothesize that when compared to patients receiving treatment at agencies providing standard care, participants receiving treatment at agencies implementing these AHRQ guidelines will have increased attempts to quit smoking; increased readiness to quit smoking; increased smoking cessation/abstinence; and, decreased amount of smoking per day. We also hypothesize that increased duration of intervention and fidelity to guidelines will produce better outcomes. A quasi-experimental study will compare patients receiving care consistent with the AHRQ practice guidelines to patients receiving care that is not consistent with the practice guidelines. Six randomly selected outpatient mental health clinics in Maryland will be enrolled; 3 will be randomly assigned to implement the guidelines immediately (experimental condition) and will implement the guidelines for 12 months, and 3 will delay implementation of the guidelines for six months (control condition) and then implement the guidelines for 6 months. To assess patient outcomes, a randomly selected sample of 63 schizophrenia patients at each clinic (total initial enrollment 378) will be assessed at three time points. Accounting for attrition, we estimate a final sample of at least 50 participants per clinic (150per condition, 300 total) for our first hypothesis. Implementation of practice guidelines will be achieved by intensive training of staff at study sites, ongoing monitoring and assistance, and providing clinic incentives. Fidelity will be closely monitored by a chart review and participant interview. The design suggests a hierarchical data structure, i.e., individual patients are nested within physicians and physicians are nested within clinics. Thus, a multilevel analysis will be utilized to address the research hypotheses. This technique has numerous advantages over traditional multiple regression (or ANCOVA) analysis, including capacity to test hypotheses about cross-level effects (e.g., how AHRQ implementation (a physician-level predictor) affects patient-level outcomes. It also accommodates subjects with missing data, and non-independence of measures within-class (physician or clinic) or intra-class correlation can be estimated and controlled.