Reducing Hospital Readmission Rates by Implementing an Inpatient Tobacco Cessation Service Driven by Interactive-Voice Recognition Technology

通过实施交互式语音识别技术驱动的住院戒烟服务来降低再入院率

• 批准号: 8871183
• 负责人: Kathleen Buford Cartmell
• 金额: $ 13.92万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8871183
• 关键词: Reducing; Hospital; Readmission; Rates; Implementing

There is good reason to believe that providing tobacco cessation services to patients while hospitalized can improve clinical outcomes for patients. smoking increases a patient's risk for a host of negative clinical outcomes, including treatment-related toxicities and complications, medication side effects, and reduced performance status. intervening with patients while hospitalized offers several advantages. First, patients are not permitted to smoke while in the hospital and temporary smoking abstinence may serve as a catalyst to help them remain tobacco free after discharge. second, the illness that brought patients to the hospital may serve to motivate them to refrain smoking. third, hospitalized smokers have access to medical professionals and medications to assist in refraining smoking. thus, the joint commission jc has recommended that hospitals screen all patients for tobacco use and offer cessation services and follow up support within 1 month of discharge. Unfortunately, few hospitals implement the jc tobacco treatment standards in part because the services require extra costs, the standards are voluntary, and the financial benefits to hospitals and insurers have yet to be documented. in the future, national health policy changes may incentivize hospitals and insurers to explore how smoking cessation services may help to control healthcare costs. for example, the centers for medicare and medicaid will penalize hospitals whose 30-day readmission rates exceed allowable limits for 5 conditions: 1 acute mi, 2 heart failure, 3 pneumonia, 4 copd and 5 hip/knee replacement. the medical university of south carolina recently implemented an automated in-hospital smoking cessation program using ivr technology to follow-up with patients post-discharge in accordance with jc standards. this study takes advantage of in-place data capture mechanisms that allow efficient linkage between hospital clinical system, cessation program and statewide healthcare utilization datasets to examine hospital readmission and cost outcomes. the proposed study will use an interrupted time series design to examine monthly trends in readmission rates before 01/01/13-12/31/13 and after 02/01/14-01/31/15 program implementation, allowing us to test the hypothesis that an automated inpatient smoking cessation program will reduce unplanned readmissions and healthcare costs. this study provides an efficient way to examine whether investing in tobacco cessation services can help hospitals to avoid readmission penalties and reduce healthcare costs via secondary data analyses.

There有充分的理由相信，在住院期间为患者提供戒烟服务可以改善患者的临床结果。吸烟增加了患者一系列负面临床结果的风险，包括与治疗相关的毒性和并发症、药物副作用以及表现状态下降。在住院期间对病人进行干预有几个好处。首先，病人在住院期间不允许吸烟，暂时的戒烟可以作为催化剂，帮助他们在出院后保持无烟。第二，把病人带到医院的疾病可能会激励他们戒烟。第三，住院吸烟者可以获得医疗专业人员和药物来帮助他们戒烟。因此，联合委员会建议医院筛查所有患者的烟草使用情况，并在出院后1个月内提供戒烟服务和后续支持。遗憾的是，很少有医院执行jc烟草治疗标准，部分原因是这些服务需要额外费用，这些标准是自愿的，医院和保险公司的经济利益尚未得到证明。未来，国家卫生政策的变化可能会激励医院和保险公司探索戒烟服务如何帮助控制医疗成本。例如，医疗保险和医疗补助中心将对在5种情况下30天再入院率超过允许限制的医院进行处罚：1种急性心肌梗死，2种心力衰竭，3种肺炎，4种慢性阻塞性肺病和5种髋关节/膝关节置换术。南卡罗来纳医科大学最近实施了一项自动院内戒烟计划，使用ivr技术根据jc标准对出院后的患者进行随访。本研究利用就地数据捕获机制，允许医院临床系统、戒烟计划和全州医疗保健利用数据集之间的有效联系，以检查医院再入院和成本结果。拟议的研究将使用中断时间序列设计来检查2013年1月1日至12月31日之前和2014年2月1日至15年1月31日计划实施之后再入院率的每月趋势，使我们能够检验自动住院戒烟计划将减少计划外再入院率和医疗费用的假设。本研究提供了一种有效的方法，通过二次数据分析来检验投资戒烟服务是否可以帮助医院避免再入院处罚并降低医疗成本。