Implementation of HIT-Enhanced Tobacco Treatment for Hospitalized Smokers

对住院吸烟者实施 HIT 强化烟草治疗

基本信息

批准号：
8337887
负责人：
Steven L Bernstein
金额：
$ 80.02万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-06 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8337887
关键词：
18 year old Abstinence Academic Detailing Accounting Acute Acute myocardial infarction Admission activity Adult Age American Bupropion Caring Cessation of life Cigarette Clinical Practice Guideline Computerized Medical Record Congestive Heart Failure Consumption Cost Effectiveness Analysis Counseling Dependence Economics Education Effectiveness Electronics Emergency Medicine Evidence based intervention Evidence based treatment Goals Health Personnel Healthcare Hospitalists Hospitalization Hospitals Individual Inpatients Instruction Internal Medicine Intervention Joints Learning Measures Nurses Nursing Assessment Nursing Education Outcome Measure Outpatients Overweight Pamphlets Patient Discharge Patients Performance Pharmaceutical Preparations Pharmacotherapy Physical Examination Physicians Pneumonia Population Poverty Pregnancy Primary Health Care Provider Quality-Adjusted Life Years Race Recording of previous events Regulation Relative (related person)Reporting Research Personnel Resources Services Smoke Smoker Smoking Societies Source System Telefacsimile Telephone Text Time Tobacco Tobacco Dependence Tobacco use Training United States United States Centers for Medicare and Medicaid Services United States Public Health Service Workplace arm cigarette smoking cohort computerized physician order entry cost cost effective cost effectiveness economic cost evidence base experience follow-up health information technology implementation science improved meetings nicotine replacement novel prevent profession allied to medicine programs quitline randomized trial smoking cessation smoking prevalence standard of care tobacco abstinence tobacco control tobacco screening varenicline

项目摘要

DESCRIPTION (provided by applicant): Forty-six million US smokers account for 6-12 million hospitalizations each year. These admissions provide a teachable moment for tobacco control. Advances in health information technology (HIT), like electronic medical records (EMR), provide an opportunity to implement evidence-based, cost-effective, sustainable programs in tobacco treatment for hospitalized smokers. The overall goal of this proposal is to study the effectiveness of a novel Integrated Tobacco Order Set (ITOS), embedded within an EMR, in promoting sustained smoking abstinence in a cohort of adult inpatients. We propose a 2-arm trial, randomized by provider, of ITOS + Academic Detailing (AD) at Yale-New Haven Hospital (YNHH) compared to AD alone. Subjects admitted to physicians in the AD arm may receive a smoking cessation brochure and medications ordered electronically, our standard of care. Providers in the ITOS arm will access an electronic order set that includes: (1) medication orders for varenicline, bupropion and nicotine replacement therapy; (2) a fax automatically sent to the patient's primary care provider, informing him/her of the initiation of tobacco treatment (3 an electronic fax sent to the state smokers' quitline (QL) for post-discharge treatment (4) a prompt at discharge encouraging prescription of outpatient pharmacotherapy, and (5) a set of 5 or more QL-initiated counseling calls to subjects for 2 months post-discharge. Prior to study initiation, internal medicine and emergency medicine housestaff and hospitalists will be trained in tobacco treatment. ITOS will be activated, and will cover all inpatient units. Outcome measures include biochemically confirmed tobacco abstinence and an economic analysis. Follow-up will be done at 1, 6, and 12 months. The primary aim of this project is to determine whether ITOS+AD compared to AD improves 12-month smoking cessation in 960 smokers age > 18 years admitted to YNHH. Secondary aims are to 1) evaluate ITOS's ability to encourage smokers to engage in treatment; 2) assess ITOS's ability to enhance inpatient treatment of smoking; and 3) conduct an economic analysis of the intervention. Study findings and a toolkit will be disseminated through various professional societies and organizations. The study team consists of an outstanding group of investigators with rich experience in tobacco treatment, provider training, implementation science, and HIT. PUBLIC HEALTH RELEVANCE: Millions of smokers are admitted each year to US hospitals. These admissions may be a good time to begin treating tobacco dependence. This study will evaluate whether an electronic order set can improve the treatment of hospitalized smokers, and reduce their prevalence of smoking.

描述（由申请人提供）：美国四十万美国吸烟者每年住院6-1200万。这些入院为烟草控制提供了一个可教的时刻。卫生信息技术的进步（HIT），例如电子病历（EMR），为在住院吸烟者的烟草治疗中实施基于证据的，具有成本效益的可持续性计划提供了机会。该提案的总体目标是研究嵌入EMR内的新型综合烟草订单集（ITO）的有效性，以促进成人住院患者队列中持续的戒烟。我们提出了一项由耶鲁大学新避风港医院（YNHH）的ITOS +学术细节（AD）随机分配的2臂试验，而与单独的AD相比。 AD部门的医生接纳的受试者可能会收到我们的护理标准以电子方式订购的戒烟手册和药物。 ITOS ARM中的提供商将访问一个电子订单集，其中包括：（1）Varenicline，Bupropion和Nicotine替代疗法的药物订单； (2) a fax automatically sent to the patient's primary care provider, informing him/her of the initiation of tobacco treatment (3 an electronic fax sent to the state smokers' quitline (QL) for post-discharge treatment (4) a prompt at discharge encouraging prescription of outpatient pharmacotherapy, and (5) a set of 5 or more QL-initiated counseling calls to subjects for 2 months post-discharge. Prior to study内科医学和急诊医学家将接受烟草治疗的培训，并将涵盖所有患者的成果措施，包括生物化学确认的。 YNHH的18年是对1）评估ITOS鼓励吸烟者进行治疗的能力； 2）评估ITOS增强吸烟的住院治疗的能力； 3）对干预进行经济分析。研究发现和工具包将通过各种专业社会和组织传播。研究团队由一群杰出的研究人员组成，在烟草治疗，提供者培训，实施科学和HIT方面具有丰富经验。公共卫生相关性：每年将数百万吸烟者送往美国医院。这些入院可能是开始治疗烟草依赖性的好时机。这项研究将评估电子订单集是否可以改善住院吸烟者的治疗，并降低吸烟的患病率。