Changing Pediatric Office Systems Nationally to Address Parental Tobacco Use

在全国范围内改变儿科办公室系统以解决父母吸烟问题

• 批准号: 8518256
• 负责人: Jonathan P Winickoff
• 金额: $ 90.76万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8518256
• 关键词: Abstinence; Academy; Address; Adherence; Adoption; Affect; American; Certification; Child; Childhood; Clinical; Collaborations; Cotinine; Counseling; Effectiveness of Interventions; Enrollment; Environmental Risk Factor; Family; Goals; Grant; Guidelines; Healthcare; Home environment; Institutionalization; Intervention; Investments; Leadership; Maintenance; Measures; Medicaid; Medication Management; Medicine; Methods; Names; Outcome; Outpatients; Parenting behavior; Parents; Patient Self-Report; Pediatrics; Performance; Pharmaceutical Preparations; Pharmacotherapy; Phase; Phase II Clinical Trials; Prevention; Process; Professional Organizations; Research; Resources; Sampling; Services; Site; Smoke; Smoking; Source; Surveys; System; Tobacco Dependence; Tobacco use; Training; United States; United States Agency for Healthcare Research and Quality; United States National Institutes of Health; Visit; Work; arm; base; behavior change; chronic care model; cost; cost effective; cost effectiveness; evidence base; evidence based guidelines; innovation; nicotine replacement; practice-based research network; primary outcome; programs; quitline; smoking cessation; success; tobacco control; treatment as usual

DESCRIPTION (provided by applicant): The goal of this renewal application is to transform routine pediatric outpatient practice to assist parents quitting smoking in order to help eliminate tobacco use in families. In our Phase I RCT (R01-CA127127), framing the intervention from the practice perspective using the Chronic Care Model (Wagner) and the Prevention System (Solberg), we demonstrated dramatic office systems changes without additional resource added to practices, showing 14-fold increased rates of delivering tobacco control assistance in a practice-based research network, and justifying significant investment to disseminate nationally. The intervention included three key implementation steps to address parental smoking in the child healthcare setting: (1) motivational messaging; (2) proactive referral to quitlines; and (3) pharmacologic management of tobacco dependence. The intervention was recently named an "innovation in medicine" by AHRQ. In the proposed Phase II trial, in close collaboration with the American Academy of Pediatrics (AAP), the largest pediatrics professional organization in the United States, we will perform a two-arm RCT to address the critical unanswered questions of generalizability, sustainability, and cost- effectiveness of the intervention using a national 20-ste sample of pediatric practices. The Phase II intervention will be augmented to address key barriers identified in Phase 1 and to enhance generalizability and sustainability by: (1) including facilitated nicotine replacement delivery-compliant with new national Medicaid coverage standards and (2) including an innovative additional dissemination and sustainability component, developed with a separate NCI ARRA grant--an online, tailored, self-paced module where clinicians work on a full practice implementation over the course of several months of self study and hands-on improvement cycles. The module satisfies the new American Board of Pediatrics Maintenance of Certification Performance in Practice requirement creating a natural "pull" for the training. The Specific Aims include: " Aim 1. to implement and sustain adherence to evidence-based guidelines at the clinical level; " Aim 2. to facilitate behavior change among parents and evaluate cost per quit among parents who smoke; " Aim 3. to study systems changes and the processes that affect them at the practice level. Building on the success of Phase 1, the generalizable training systems to be studied in this application will enhance the adoption, implementation, and sustainability of the intervention, making it widely transportable throughout pediatric practice nationally and providing a critical return on decades of NIH investment in developing the evidence base for tobacco control. The project will have significant impact by yielding an effective, theoretically-based, rapidly disseminable, and sustainable strategy to address tobacco use in families through child healthcare settings in the United States.

描述（由申请人提供）：此更新申请的目的是改变常规的儿科门诊习惯，以帮助父母戒烟，以帮助消除 在家庭中使用烟草。在我们的I阶段RCT（R01-CA127127）中，使用慢性护理模型（Wagner）和预防系统（SOLBERG）从实践角度构建了干预，我们证明了不添加实践的其他资源的急剧化办公系统变化，在实践中添加了其他资源，显示了在实践研究网络中提供了14倍的实践控制速度，从而在基于实践的研究网络中增加了大量投资，并证明了大量投资，并证明了大量投资，并证明了良好的投资。干预措施包括三个关键的实施步骤，以解决儿童医疗保健环境中的父母吸烟：（1）动机消息传递； （2）主动转介到戒烟线； （3）烟草依赖的药理管理。该干预措施最近被AHRQ评为“医学创新”。在拟议的II阶段试验中，我们将与美国最大的儿科专业组织美国儿科学院（AAP）密切合作，我们将使用两臂RCT来解决有关使用国家20-Ste儿童练习样本的干预措施的概括，可持续性，可持续性和成本效益的关键问题。 II期干预措施将得到扩展，以解决第1阶段确定的关键障碍，并通过以下方式增强可概括和可持续性。（1）包括 通过新的国家医疗补助覆盖范围标准，辅助尼古丁替代交付兼容，包括创新的额外传播和可持续性组件，该标准是由单独的NCI ARRA Grant开发的 - 一个在线，量身定制的，自定的模块，临床医生在几个月的自我研究和动手改善的过程中进行全面实施的临床医生致力于实施全面练习。该模块满足了新的美国儿科委员会在实践中的认证绩效维护，为培训创造了自然的“拉力”。具体目的包括：“目标1。在临床一级实施和遵守基于证据的指南；”目标2。促进父母之间的行为改变并评估吸烟的父母的每次戒烟成本； “目的3。研究系统的变化以及在实践水平上影响它们的过程。基于第1阶段的成功，可以在本申请中进行研究的可推广的培训系统将增强干预的采用，实施和可持续性，从而在全国范围内广泛运输，从而使其在全国范围内广泛运输，并在整个儿科实践中可在基于NIH的数十年中的重要投资中产生重要的投资，从而有效地投资了一定有效的投资。通过美国儿童医疗保健环境解决烟草在家庭中使用的可持续战略。