An intervention in urban CHC's to increase tobacco use treatment

描述(由申请人提供)：在美国，烟草使用是可预防死亡的头号原因。然而，对循证戒烟实践的遵守情况仍远低于指南建议。更具体地说，许多研究表明，随着医生从询问烟草使用情况转向提供帮助和安排后续行动，对卫生保健研究和质量机构“烟草使用和依赖治疗”指南的遵从性下降。我们假设，如果卫生中心的工作人员能够将耗时的援助步骤委托给外部资源(电话放弃线)，他们将更有可能提供援助哥伦比亚大学邮递员公共卫生学院和纽约长老会门诊护理研究网络将与位于布法罗罗斯威尔公园癌症研究所的纽约州Quitline合作，以测试这样一种假设，即在服务于低收入、主要是非裔美国人和拉丁裔患者的社区卫生中心实施“扩展的生命体征”图表干预，并与外部主动电话咨询服务相结合，这是可行的，而且在增加接受戒烟帮助的吸烟者比例方面将比单纯的“扩大生命体征”干预更有效。具体地说，在对照中，网站的日常护理包括一个“扩展的生命体征”图表系统，提示医务助理或护士识别吸烟者，提供简短的戒烟建议，评估戒烟准备情况，并提供帮助。在干预地点，“扩展生命体征”提示与四次积极主动的电话咨询(由纽约州Quitline提供)相结合，为准备戒烟的吸烟者提供。干预地点的吸烟者将通过位于健康中心的传真或电子邮件转介系统与Quitline联系起来。以前的传播研究侧重于增加对烟草使用者的识别和戒烟建议的战略；因此，我们的主要成果将是获得援助的烟草使用者的比例。这项建议利用纽约州Quitline来测试一种转诊模式，该模式将对提供者的要求降至最低，因此有可能提高社区卫生中心在治疗烟草使用方面的有效性，并扩大基于证据的电话咨询的覆盖范围。

DESCRIPTION (Provided by the Applicant): Tobacco use is the number one cause of preventable death in the U.S. Yet, compliance with evidence-based smoking cessation practices remains well below guideline recommendations. More specifically, numerous studies demonstrate a pattern in which compliance with the Agency for Healthcare Research and Quality's "Treatment of Tobacco Use and Dependence" guideline decreases as physicians move from asking about tobacco use to providing assistance and arranging follow-up. We hypothesize that health center staff will be more likely to offer assistance if they can delegate the time consuming step of assistance to an external resource (telephone quitline) The Columbia University Mailman School of Public Health and the New York Presbyterian Ambulatory Care Research Network will partner with the New York State Quitline located at Roswell Park Cancer Institute in Buffalo to test the hypothesis that implementing an "expanded vital sign" chart intervention in community health centers serving low-income, primarily African-American and Latino patients, combined with an office-based link to an external proactive telephone counseling service, is feasible and will be more effective in increasing the proportion of tobacco users who receive cessation assistance than the "expanded vital sign" intervention alone. Specifically, in the control, sites usual care includes an "expanded vital sign" chart system that prompts the medical assistant or nurse to identify smokers, offer brief advice to quit, assess readiness to quit, and offer assistance. In intervention sites, the "expanded vital sign" prompt is coupled with four proactive telephone counseling sessions (provided by the New York State Quitline) available to smokers who are prepared to quit. Smokers in the intervention sites will be linked to the Quitline through a fax or email referral system located in the health centers. Previous dissemination studies have focused on strategies to increase identification of tobacco users and advice to quit; therefore our primary outcome will be the proportion of tobacco users who receive assistance. This proposal leverages the New York State Quitline to test a model for referrals that minimizes demands on providers and therefore has the potential to enhance the effectiveness of community health centers in treating tobacco use as well as increasing the reach of evidence based telephone counseling.