Dynamics Modeling as a Tool for Disseminating the PHS Tobacco Treatment Guideline

说明(由申请人提供)：进一步减少烟草使用要求提高初级保健医生治疗烟草依赖的准备和能力。然而，初级保健提供者在与病人进行短暂的办公室访问期间，面临着相当大的压力和后勤挑战，以解决多重预防保健问题。鼓励采用完善的临床实践指南的努力必须解决时间限制和最佳做法之间的紧张关系。在这项研究中，我们将测试这一假设，即通过使用一个模拟工具来改善当前戒烟指南在初级保健环境中的适应性，该工具可以帮助提供者比较可行的替代策略，并考虑这些策略对他们的患者和他们的实践的相对影响。拟议的工具将模拟当前PHS指南中确定的循证烟草治疗的关键过程的实施。系统动力学建模技术将用于开发、测试和验证仿真工具的输出。系统动力学模型是对动态变化的数学模拟。系统动力学建模已被证明可以促进对复杂的人类和组织问题、行动和解决这些问题的政策的更深层次的理解。我们建议的研究将嵌套在Queens Quits！中，这是一个由纽约州卫生部资助的持续项目，旨在向皇后区的医疗保健提供者传播和实施PHS指南。拟议研究的具体目的是开发一个系统动力学模拟工具，作为决策辅助工具，以促进深入了解如何最好地在实践层面上执行目前建议的治疗烟草使用和依赖的临床指南，第二，对该模拟工具进行形成性评估，评估对象为分布在不同种族的城市社区的30个初级保健实践。我们的形成性评估将检查：(1)在学术细节干预中使用模拟工具的可行性和可接受性，(2)个别提供者对烟草处理的态度和做法的变化，以及(3)实施新的或改进的办公系统，以改善实践层面的烟草处理。我们假设，实践环境的系统动力学建模将促进对PHS指南的更深入理解和更大推动。公共卫生相关性：在美国，烟草使用是导致过早死亡的主要可预防原因。每年有超过44万美国人死于与烟草有关的疾病，占死亡人数的五分之一。在美国，吸烟每年占癌症死亡人数的30%以上。吸烟也是导致心脏病、中风和慢性阻塞性肺病死亡的主要原因。从1995年到1999年，美国每年因吸烟造成的经济成本估计为755亿美元，用于成年人的直接医疗保健，以及819亿美元的生产力损失。初级保健提供者的简短咨询干预已被证明有效地促进了戒烟，但许多医生并不是在每次预约时都对所有患者始终如一地坚持这一做法。这项拟议的研究将开发和测试一种创新的干预措施，以帮助服务于不同种族的城市社区的初级保健医生实施以小灵通为基础的烟草依赖治疗做法。

DESCRIPTION (provided by applicant): Further reductions in tobacco use calls for increased readiness and capacity of primary care physicians to treat tobacco dependence. However, primary care providers face considerable pressure and logistical challenges to address multiple preventive care concerns during brief office visits with their patients. Efforts to encourage adaptation of well-established clinical practice guidelines must address the tension between time limitations and best practices. In this study, we will test the hypothesis that adaptation of the current cessation guideline in primary care settings will be improved through use of a simulation tool that can help providers compare viable alternative strategies and consider the relative impact of these strategies on their patients and their practice. The proposed tool will simulate the implementation of key processes of evidence-based tobacco treatment, as identified in the current PHS Guideline. System dynamics modeling techniques will be used to develop, test, and validate the output of the simulation tool. System dynamics models are mathematical simulations of dynamic change. System dynamics modeling has been demonstrated to promote deeper understanding of complex human and organizational problems, actions, and policies to address them. Our proposed study will be nested within Queens Quits!, an on-going project funded by the New York State Department of Health that is designed to disseminate and implement the PHS Guideline to health care providers in the Borough of Queens. The specific aims of the proposed research are to develop a system dynamics simulation tool as a decision aid for promoting in-depth understanding about how best to implement currently recommended the clinical guidelines for the treatment of tobacco use and dependence at the practice level, and, second, to conduct a formative assessment of the simulation tool with 30 primary care practices located in ethnically diverse, urban communities. Our formative assessment will examine: (1) feasibility and acceptability of using the simulation tool in an academic detailing intervention, (2) changes in individual provider attitudes about and practices in tobacco treatment, and (3) implementation of new or improved office systems to improve tobacco treatment at the practice level. We hypothesize that system dynamics modeling of the practice environment will promote deeper understanding of and greater impetus to implement the PHS Guideline. PUBLIC HEALTH RELEVANCE: Tobacco use is the leading preventable cause of premature death in the United States. Each year, more than 440, 000 Americans die of tobacco-related disease, accounting for 1 in every 5 deaths. Cigarette smoking is responsible for more than 30 percent of cancer deaths annually in the United States. Smoking also contributes substantially to deaths from heart disease, stroke, and chronic obstructive pulmonary disease. From 1995 to 1999, estimated annual smoking-attributable economic costs in the United States were $75.5 billion for direct medical care for adults and $81.9 billion for lost productivity. Brief counseling intervention by primary care providers has been shown to effectively promote tobacco use cessation, yet many physicians do not consistently adhere to this practice for all patients at each appointment. The proposed study would develop and test an innovative intervention to assist primary care physicians who serve ethnically diverse, urban communities implement PHS evidence- based practices for tobacco dependence treatment.