Implementation of HIT-Enhanced Tobacco Treatment for Hospitalized Smokers

描述（由申请人提供）：美国有4600万吸烟者，每年有600万至1200万人住院。 这些承认为烟草控制提供了一个可教的时刻。健康信息技术（HIT）的进步，如电子病历（EMR），为实施基于证据的，具有成本效益的，可持续的住院吸烟者烟草治疗计划提供了机会。本提案的总体目标是研究嵌入EMR的新型综合烟草医嘱集（ITOS）在促进成人住院患者队列持续戒烟方面的有效性。我们提出了一个2臂试验，由供应商随机，ITOS +学术细节（AD）在耶鲁纽黑文医院（YNHH）相比，AD单独。接受AD组医生治疗的受试者可能会收到戒烟手册和电子订购的药物，这是我们的标准治疗。ITOS部门的供应商将访问电子订单集，其中包括：（1）伐尼克兰、安非他酮和尼古丁替代疗法的药物订单;（2）自动发送给患者的初级保健提供者的传真，告知他/她开始烟草治疗（3）电子传真发送到国家吸烟者戒烟热线（QL），用于出院后治疗（4）出院时的提示，鼓励门诊药物治疗处方，和（5）在出院后2个月内，对受试者进行一组5次或5次以上的QL启动的咨询电话。在研究开始前，内科和急诊医务室工作人员和住院医师将接受烟草治疗培训。ITOS将被激活，并将覆盖所有住院单位。结果措施包括生物化学证实的戒烟和经济分析。将在1、6和12个月时进行随访。本项目的主要目的是确定与AD相比，ITOS+AD是否改善了960名年龄> 18岁的吸烟者在YNHH中的12个月戒烟。次要目的是：1）评估ITOS鼓励吸烟者参与治疗的能力; 2）评估ITOS加强住院吸烟治疗的能力; 3）对干预措施进行经济分析。研究结果和工具包将通过各种专业协会和组织传播。研究团队由一组优秀的研究人员组成，他们在烟草治疗、提供者培训、实施科学和HIT方面具有丰富的经验。 公共卫生相关性：每年有数百万吸烟者被送往美国医院。这些入院可能是开始治疗烟草依赖的好时机。本研究将评估电子医嘱集是否可以改善住院吸烟者的治疗，并降低他们的吸烟率。

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.