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

描述（由申请人提供）：烟草使用是美国可预防性死亡的头号原因。然而，遵守基于证据的戒烟实践仍远低于指南建议。更具体地说，许多研究表明，随着医生从询问烟草使用转向提供帮助和安排随访，对医疗保健研究和质量机构的“烟草使用和依赖治疗”指南的依从性降低。我们假设，如果健康中心的工作人员能够将耗时的援助步骤委托给外部资源（电话戒烟热线），他们将更有可能提供帮助。哥伦比亚大学梅尔曼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戒烟热线合作，以测试在社区实施“扩展生命体征”图表干预的假设为低收入、主要是非裔美国人和拉丁裔患者提供服务的保健中心，加上在办公室与外部主动电话咨询服务建立联系，是可行的，而且在增加接受戒烟援助的烟草使用者比例方面，将比单独采用“扩大生命体征”干预更有效。具体来说，在对照组中，现场的常规护理包括一个“扩展生命体征”图表系统，提示医疗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。在干预站点，“扩展生命体征”提示与四个主动电话咨询会议（由纽约州戒烟热线提供）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设在卫生中心的传真或电子邮件转介系统与戒烟热线联系起来。以前的传播研究侧重于加强识别烟草使用者和建议戒烟的战略；因此，我们的主要结果将是获得援助的烟草使用者的比例。该提案利用纽约州戒烟热线来测试一种转诊模式，该模式最大限度地减少了对提供者的要求，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，并增加基于证据的电话咨询的覆盖面。

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.