Implementation of HIT-Enhanced Tobacco Treatment for Hospitalized Smokers

描述(由申请者提供)：4600万美国吸烟者每年有600-1200万人住院治疗。这些承认为控烟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)，为住院吸烟者实施以证据为基础、成本效益高、可持续的烟草治疗计划提供了机会。这项建议的总体目标是研究嵌入EMR中的新型综合烟草订单集(ITOS)在促进成人住院患者队列中持续戒烟方面的有效性。我们建议在耶鲁-纽黑文医院(YNHH)进行一项按提供者随机化的双臂试验，将ITOS+学术细节(AD)与单独使用AD进行比较。住进AD组医生的受试者可能会收到戒烟手册和电子订购的药物，这是我们的护理标准。ITOS分支机构的提供者将访问电子订单集，其中包括：(1)varenicline、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电子传真发送到州吸烟者戒烟热线(QL)进行出院后治疗)；(4)出院时鼓励处方门诊药物治疗的提示；以及(5)一套5个或更多QL发起的咨询电话，在出院后2个月内向受试者发出咨询电话。在学习开始之前，内科和急诊医生将接受烟草治疗方面的培训。ITOS将被激活，并将覆盖所有住院病房。结果衡量标准包括生化确认的烟草戒断和经济分析。随访时间分别为1、6、12个月。这个项目的主要目的是确定与AD相比，Itos+AD是否能在960名18岁入院的吸烟者中改善12个月的戒烟效果。次要目标是：1)评估ITOS鼓励吸烟者接受治疗的能力；2)评估ITOS加强住院治疗吸烟的能力；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。研究团队由一批在烟草治疗、供应商培训、实施科学和HIT方面具有丰富经验的优秀调查人员组成。

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.