Transforming The Treatment of Tobacco Use in Health Care: Seizing The Potential of the Electronic Health Record to Deliver Comprehensive Chronic Care Treatment for Smoking

 描述(申请人提供)：吸烟控制着超过4000万美国人，每年导致超过48万美国人患上毁灭性的疾病、严重的经济损失和悲惨的死亡。烟草使用是癌症的首要可预防原因，三分之一的癌症死亡是由烟草直接造成的。如果我们大幅提高每年就诊的70%吸烟者的戒烟率，这一重大损失将大大减少。尽管有多种有效的吸烟治疗方法，尽管电子健康记录(EHR)等强大的健康信息技术，但在就诊期间得到有效治疗的吸烟者太少了。这在很大程度上是由于翻译科学的失败；治疗研究的大部分翻译都是靠猜测和直觉。这份R35杰出的研究人员提案将通过一组独特的现实合作伙伴解决烟草科学转化的巨大需求：威斯康星州的医疗系统将作为“初级保健实验室”，世界领先的电子健康记录供应商，以及由国际烟草公司Michael Fiore领导的全国知名的戒烟研究团队。这些合作伙伴建议：1)开发和应用高效和新颖的研究方法，以推进方法上的原则性干预翻译；2)设计和测试基于EHR的高效治疗支持系统，该系统组织戒烟治疗并促进其传播；3)通过向初级保健患者提供真正全面的慢性护理吸烟治疗来提高治疗效果。因此，将利用电子健康记录的变化和开创性的研究方法来重新设计医疗保健提供系统，以便高效、无缝地为每年访问初级保健机构的近3000万吸烟者中的绝大多数组织和提供最先进的治疗。吸烟治疗及其支持系统将被设计为随时在卫生系统和各种电子健康记录平台上传播。转化性研究方法应该有利于任何试图转译预防性卫生干预措施的人。拟议的首席调查员在减少烟草使用及其造成的危害方面有26年的记录。他作为执业医生、烟草控制科学家和国家吸烟政策设计者的经历，反映了实现R35机制目标的巨大潜力--彻底改变烟草使用治疗的提供，以防止数百万癌症死亡。

 DESCRIPTION (provided by applicant): Smoking maintains its grip on over 40 million Americans, resulting in devastating illness, grievous economic loss, and tragic death for over 480,000 Americans each year. Tobacco use is the leading preventable cause of cancer, directly responsible for 1/3 of cancer deaths. This profound toll would be dramatically reduced if we substantially boosted rates of cessation among the 70% of smokers making healthcare visits each year. Despite multiple effective smoking treatments, and despite powerful health information technologies such as the electronic health record (EHR), far too few smokers get effective treatment during their healthcare visits. This is largely due to a failure of translatioal science; much translation of treatment research occurs by guesswork and hunch. This R35 Outstanding Investigator proposal will address the great need for translation of tobacco science via a unique set of real-world partners: a Wisconsin health system that will serve as a "primary care laboratory," the world's leading EHR vendor, and a nationally renowned tobacco cessation research team led by the PI, Michael Fiore. These partners propose to: 1) develop and apply highly efficient and novel research methods to advance methodologically principled intervention translation, 2) design and test a highly efficient EHR-based treatment support system that organizes tobacco cessation treatment and fosters its dissemination, and 3) increase treatment effectiveness by delivering truly comprehensive chronic care smoking treatment to primary care patients. Thus, EHR changes and groundbreaking research methods will be used to re-engineer healthcare delivery systems to efficiently and seamlessly organize and deliver state-of-the-art treatment to the great majority of the nearly 30 million smokers visiting primary care settings each year. The smoking treatment and its support system will be designed for ready dissemination across health systems and diverse EHR platforms. The translational research methods should benefit any attempt to translate preventive health interventions. The proposed Principal Investigator has a 26-year track record of reducing tobacco use and its resulting harms. His experiences as a practicing physician, tobacco control scientist, and designer of national smoking policies, reflect enormous potential to fulfill the goals of the R35 mechanism - to revolutionize the delivery of tobacco use treatment so as to prevent literally millions of cance deaths.