Pediatric Emergency Department Decision Support System to Reduce Secondhand Smoke

儿科急诊科决策支持系统减少二手烟

• 批准号: 8977498
• 负责人: JUDITH SARAH GORDON
• 金额: $ 19.84万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-12-03 至 2017-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8977498
• 关键词: Accident and Emergency department; Adult; Asthma; Attitude; Behavior; Bronchiolitis; Caregivers; Child; Child Behavior; Child health care; Childhood; Cigarette; Clinical; Clinical Practice Guideline; Computer software; Computerized Medical Record; Cotinine; Counseling; Data; Data Reporting; Decision Support Systems; Elements; Emergency Nursing; Emergency Situation; Emergency department visit; Ensure; Environmental Tobacco Smoke; Feedback; Focus Groups; Guidelines; Health; Home environment; Incentives; Individual; Institution; Intervention; Link; Modeling; Morbidity - disease rate; Motivation; Online Systems; Outcome; Participant; Patient Self-Report; Phase; Prevalence; Procedures; Program Development; Recommendation; Reporting; Research; Resources; Respiratory Tract Infections; Salivary; Smoke; Smoker; Smoking; Smoking Behavior; Structure; System; Test Result; Testing; Text; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Training; Training Programs; Visit; Withholding Treatment; Work; base; cost; design; environmental tobacco smoke exposure; evidence base; follow-up; improved; innovation; interest; programs; prototype; quitline; respiratory; satisfaction; screening; smoking cessation; tobacco screening; tool

 DESCRIPTION (provided by applicant): Second-hand smoke exposure (SHSe) is unequivocally harmful to children's health as evidenced by increased rates of asthma, bronchiolitis, and respiratory infections. Up to 48% of children who visit the pediatric emergency department (PED) are exposed to SHS. Our research has shown that tobacco interventions are feasible and effective in the PED setting. However, PED nurses (RNs) do not deliver SHSe counseling in a systematic way due to barriers such as lack of training, time, and structured systems. The Clinical Practice Guidelines for Treating Tobacco Use and Dependence (CPGs) recommends that pediatric practitioners treat adult caregivers who smoke in all clinical encounters by using: 1) electronic medical records (EMR) to document tobacco use and SHSe, 2) "prompts" within a decision support system (DSS) to promote cessation counseling and urge all smokers to quit, and 3) advice to all smokers that the only effective protection from SHSe is to make their homes and cars smoke-free. The expanded use of the EMR to prompt RNs to treat tobacco dependence and provide feedback has been used successfully in adult settings, and provides a means to standardize screening and counseling of adult tobacco users in the PED. However, DSS tools designed to facilitate SHSe reduction have not been developed for use in the PED. We propose a study that will be the first to develop and evaluate a PED DSS-EMR System to facilitate the identification of smokers and the delivery of a SHSe intervention to caregivers who bring their child to the PED. We will conduct a two- phased project to develop, refine, and integrate an Epic-based DSS, using the CPGs, our prior PED cessation work, and our effective web-based cessation training program. In Phase I, we will develop a three-part DSS with prompts to: 1) ASK about child SHSe and caregiver smoking using the same screening prompts required by the Meaningful Use incentive program, 2) Use a free software program (REDCap) to ADVISE caregivers to reduce their child's SHSe via total smoking home and car bans and quitting smoking, and 3) ASSIST caregivers to quit by directly connecting them to their choice of free cessation resources (e.g., Quit- line, txt2quit, smokefree.gov) during the PED visit. We will create reports to provide feedback to RNs on their SHSe counseling behaviors. RNs will provide input on program content, functions, and design. In Phase II, we will conduct a 3-month feasibility trial to test the results of implementing our DSS on changes in RN SHSe-related behaviors, and child and caregiver outcomes. If effective, program results, procedures, and REDCap templates will be disseminated easily. The DSS will use a system of prompts and templates that can be modified, shared and used in all emergency settings (e.g., pediatric or adult), regardless of EMR type. Compliance and interest in the DSS will be increased by incorporating the widely-used Meaningful Use tobacco recording requirements, further increasing relevance to other institutions. This systems-based approach has the potential to reach at least 12 million smokers a year and significantly reduce SHSe-related pediatric illnesses and related costs.

 描述（由申请人提供）：二手烟暴露（SHSe）对儿童健康无疑有害，哮喘、细支气管炎和呼吸道感染的发病率增加就是证明。高达48%的儿童谁访问儿科急诊科（PED）暴露于SHS。我们的研究表明，烟草干预措施在PED环境中是可行和有效的。然而，PED护士（RNs）不提供SHSe咨询系统的方式，由于缺乏培训，时间和结构化的系统等障碍。治疗烟草使用和依赖的临床实践指南（CPGs）建议儿科医生通过使用以下方法治疗在所有临床接触中吸烟的成年护理人员：1）电子病历（EMR）记录烟草使用和SHSe，2）决策支持系统（DSS）内的“提示”，以促进戒烟咨询并敦促所有吸烟者戒烟，3）建议所有吸烟者，防止SHSe的唯一有效保护措施是使他们的家庭和汽车无烟。扩大使用EMR来促使RN治疗烟草依赖并提供反馈已成功用于成人环境，并提供了一种在PED中对成人烟草使用者进行标准化筛查和咨询的方法。然而，旨在促进SHSe减少的DSS工具尚未开发用于PED。我们提出了一项研究，这将是第一个开发和评估PED DSS-EMR系统，以促进识别吸烟者和提供SHSe干预的照顾者谁把他们的孩子到PED。我们将开展一个分两个阶段的项目，利用CPG、我们之前的PED戒烟工作和我们有效的基于网络的戒烟培训计划，开发、完善和整合基于Epic的DSS。在第一阶段，我们将开发一个由三部分组成的决策支持系统，并提示：1）使用有意义使用激励计划所要求的相同筛选提示询问儿童SHSe和护理人员吸烟情况，2）使用免费软件程序（REDCap）建议护理人员通过全面禁止在家和汽车吸烟以及戒烟来减少他们孩子的SHSe，和3）通过直接将护理人员与他们选择的免费戒烟资源（例如，Quit- line，txt2quit，smokefree.gov） PED访问。我们将创建报告，以提供反馈给RN对他们的SHSe咨询行为。RN将提供有关程序内容、功能和设计的输入。在第二阶段，我们将进行为期3个月的可行性试验，以测试实施我们的DSS对RN SHSe相关行为以及儿童和护理人员结果的变化的结果。如果有效，计划结果，程序和REDCap模板将很容易传播。DSS将使用一个提示和模板系统，可以在所有紧急情况下修改、共享和使用（例如，儿童或成人），无论EMR类型如何。通过纳入广泛使用的有意义使用烟草记录要求，将增加对DSS的遵守和兴趣，进一步增加与其他机构的相关性。这种基于系统的方法有可能每年达到至少1200万吸烟者，并显着减少与SHSe相关的儿科疾病和相关费用。

项目成果

Electronic Health Record Classification of Tobacco Smoke Exposure and Cotinine Levels in Hospitalized Pediatric Patients.

• DOI: 10.1542/hpeds.2018-0247
• 发表时间: 2019-09-01
• 期刊: Hospital pediatrics
• 作者: Mahabee-Gittens, E Melinda;Merianos, Ashley L;Matt, Georg E
• 通讯作者: Matt, Georg E

Depiction of Health Effects of Electronic Cigarettes on YouTube.

• DOI: 10.3109/14659891.2015.1118565
• 发表时间: 2016
• 期刊: Journal of substance use
• 影响因子: 0.8
• 作者: Merianos AL;Gittens OE;Mahabee-Gittens EM
• 通讯作者: Mahabee-Gittens EM

Utilization of a Clinical Decision Support Tool to Reduce Child Tobacco Smoke Exposure in the Urgent Care Setting.

利用临床决策支持工具在紧急护理环境中减少儿童烟草烟雾。

• DOI: 10.1097/pec.0000000000001646
• 发表时间: 2020-11
• 期刊: Pediatric emergency care
• 影响因子: 1.4
• 作者: Mahabee-Gittens EM;Merianos AL;Dexheimer JW;Meyers GT;Stone L;Tabangin M;Khoury JC;Gordon JS
• 通讯作者: Gordon JS