Comparative Effectiveness of Post-Discharge Strategies for Hospitalized Smokers

住院吸烟者出院后策略的比较效果

基本信息

批准号：
8440303
负责人：
NANCY A RIGOTTI
金额：
$ 77.61万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
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：
2012-03-07 至 2017-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8440303
关键词：
Acute Adherence Admission activity Adopted Adoption Adult Aftercare Automation Bupropion Caring Cause of Death Cotinine Counseling Diagnosis Effectiveness Effectiveness of Interventions Enrollment FDA approved General Hospitals Guidelines Health Health system Healthcare Hospital Mortality Hospitals Individual Intervention Joints Life Life Expectancy Link Long-Term Care Massachusetts Measures Medicare Meta-Analysis Modeling Outcome Outcome Measure Outcome Study Patients Pennsylvania Pharmaceutical Preparations Pharmacotherapy Population Prevalence Principal Investigator Professional counselor Provider Randomized Relapse Research Design Risk Services Site Smoker Smoking Smoking Cessation Intervention Subgroup System Telephone Testing Tobacco Tobacco Dependence Tobacco use Translating Translations Triage United States Public Health Service Voice Withholding Treatment Work cigarette smoking clinical practice comparative effectiveness cost cost effective cost effectiveness effective intervention effective therapy effectiveness trial efficacy research efficacy trial evidence base experience follow-up health care service utilization hospital readmission innovation interest intervention effect medication compliance meetings mortality nicotine replacement novel policy implication primary outcome programs public health relevance quitline response smoking cessation smoking intervention standard care tobacco abstinence uptake varenicline

项目摘要

DESCRIPTION (provided by applicant): Cigarette smoking is the leading preventable cause of death in the U.S. The 2008 US Public Health Service Smoking Cessation Guideline recommends offering effective treatment that includes both medication and counseling to smokers in all health care settings, including hospitals. Nearly 4 million smokers are hospitalized each year, and hospital admission offers a "teachable moment" for intervention. In-hospital smoking cessation intervention is efficacious, but only if contact continues for >1 month after discharge. The challenge is to translate this efficacy from research into clinical practice by identifying an evidence-based cost-effective model that U.S. hospitals can adopt. The major barrier is sustaining contact after discharge. This project tests an innovative strategy to efficiently sustain patient contact after discharge by streamlining the delivery of post- discharge smoking interventions in order to maximize their uptake. Specific Aim: To test the effectiveness of an innovative strategy to increase hospitalized smokers' long-term tobacco abstinence rate by maximizing their use of evidence-based tobacco treatment (counseling and medication) after hospital discharge. Study Design: A multi-site randomized controlled comparative effectiveness trial will enroll 1350 adult smokers admitted to 3 acute care hospitals in Massachusetts and Pennsylvania. All subjects will receive a brief in-hospital smoking intervention and be randomly assigned at discharge to either Standard Care (referral to the MA or PA state quitline) or Extended Care, consisting of a 3-month program with 2 components: (1) Free Medication: A 30- day supply of FDA-approved medication (nicotine replacement, bupropion, or varenicline) given at hospital discharge and refillable free for a total of 90 days to facilitate medication use and adherence; (2) Interactive Voice Response (IVR) Triage to Telephone Counseling from a national quitline provider (Free & Clear). IVR is proactive. It aims to encourage medication adherence and enhance counseling efficiency by identifying smokers who need post-discharge support. Immediate transfer of a patient from automated IVR call to a live telephone counselor will facilitate a successful connection to counseling. Using a national quitline provider offers efficient scaling. Outcomes, assessed at 1, 3, and 12 months after hospital discharge, are: (1) intervention effectiveness (cotinine-validated 7-day point-prevalence tobacco abstinence rate at 12 month follow-up [1o outcome] and other measures of tobacco abstinence); (2) smoking cessation treatment utilization, and (3) cost-effectiveness (cost per quit). An exploratory analysis will examine the intervention's effect on health and health care utilization (hospital readmission and mortality in the 12 months after discharge). Policy implication: Standard Care meets current Medicare and Joint Commission National Hospital Quality Measures (NHQM) for tobacco. Extended Care meets the revised tobacco NHQM that are being reviewed for adoption. This trial of Extended Care will provide strong evidence about the proposed hospital quality measure revisions and could offer U.S. hospitals an evidence-based way to comply with them.

描述（由申请人提供）：吸烟是美国2008年美国公共卫生服务戒烟指南的主要预防死亡原因，建议在包括医院在内的所有医疗保健环境中为吸烟者提供药物和咨询，包括药物和咨询。每年有近400万吸烟者住院，住院提供干预的“可教时刻”。院内戒烟干预是有效的，但前提是在出院后接触持续> 1个月。面临的挑战是通过确定美国医院可以采用的基于证据的成本效益模型，将这种功效从研究转化为临床实践。主要障碍是在出院后维持接触。该项目测试了一种创新的策略，可通过简化出院后的吸烟干预措施来有效维持患者接触，以最大程度地提高其摄取。具体目的：测试创新策略的有效性，以通过在出院后最大程度地利用基于证据的烟草治疗（咨询和药物）来提高住院吸烟者的长期烟草禁欲率。研究设计：一项多站点随机对照比较有效性试验将招募1350名成年吸烟者，该吸烟者被马萨诸塞州和宾夕法尼亚州的3家急诊医院录取。 All subjects will receive a brief in-hospital smoking intervention and be randomly assigned at discharge to either Standard Care (referral to the MA or PA state quitline) or Extended Care, consisting of a 3-month program with 2 components: (1) Free Medication: A 30- day supply of FDA-approved medication (nicotine replacement, bupropion, or varenicline) given at hospital discharge and refillable free for a total of 90 days促进药物使用和依从性；（2）互动语音响应（IVR）分类为国家Quitline提供商的电话咨询（Free＆Clear）。 IVR是主动的。它旨在通过确定需要放电后支持的吸烟者来鼓励药物依从性并提高咨询效率。立即将患者从自动化IVR呼叫转移到现场电话顾问将有助于成功与咨询联系。使用国家Quitline提供商提供有效的扩展。在出院后1、3和12个月评估的结果是：（1）干预效率（可替氨酸验证的7天点恢复活力的烟草在12个月的随访[1O结果]和其他烟草戒烟的措施）；（2）戒烟治疗利用和（3）成本效益（每次退出成本）。探索性分析将检查干预措施对健康和医疗保健利用的影响（出院后12个月内的医院再入院和死亡率）。政策含义：标准护理符合当前的医疗保险和联合委员会国家医院质量指标（NHQM）。扩展护理符合正在审查采用的修订后的NHQM。这项扩展护理试验将为拟议的医院质量措施修订提供有力的证据，并可以为美国医院提供一种基于证据的方式来遵守它们。