Meaningful Use and Treatment of Smoking in Federally-Qualified Health Centers

在联邦合格的健康中心有意义地使用和治疗吸烟

• 批准号: 9198217
• 负责人: Steffani R Bailey
• 金额: $ 17万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-15 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198217
• 关键词: Address; Adopted; American; Area; Award; Biometry; Cause of Death; Cessation Research; Characteristics; Clinic; Clinical; Clinical Practice Guideline; Clinical Psychology; Communities; Congresses; Counseling; Data; Development; Doctor of Philosophy; Effectiveness; Electronic Health Record; Eligibility Determination; Environment; Epidemiology; Equation; Family Practice; Federally Qualified Health Center; Future; Goals; Health Personnel; Health Professional; Health Sciences; Hospitals; Incentive Reimbursement; Incentives; Insurance; Interview; Knowledge; Link; Logistics; Measurable; Measures; Medicaid; Medical; Medicare; Mentors; Methodology; Methods; Modeling; National Institute of Drug Abuse; Nicotine Dependence; Office Visits; Oregon; Outcome; Patients; Peer Review; Pharmaceutical Preparations; Policies; Policy Maker; Preparation; Prevention Research; Primary Health Care; Process; Provider; Public Health; Publications; Qualitative Methods; Randomized Clinical Trials; Readiness; Recovery; Regression Analysis; Research; Research Assistant; Research Methodology; Research Personnel; Resources; Services; Smoking; Smoking Cessation Intervention; Smoking Status; Statutes and Laws; Structure; Substance Abuse Detection; Technology; Testing; Text; Time; Tobacco Dependence; Tobacco use; Training; Training Activity; Underserved Population; United States; United States Centers for Medicare and Medicaid Services; Universities; Withholding Treatment; base; brief advice; career; career development; clinical practice; craving; design; drug abuse prevention; evidence based guidelines; experience; follow-up; health disparity; health information technology; improved; innovation; member; multidisciplinary; patient population; population based; primary care setting; professor; programs; public health relevance; randomized trial; skills; smoking cessation; standard of care; willingness

DESCRIPTION (provided by applicant): Candidate: Dr. Steffani Bailey has her PhD in clinical psychology and is a Research Assistant Professor in the Department of Family Medicine at Oregon Health & Science University. Dr. Bailey has conducted lab-based studies on craving processes, and directed two randomized clinical trials for smoking cessation in community- based populations. She has 19 peer-reviewed publications, with 9 as first author. Dr. Bailey's previous research experience in smoking cessation, the training activities proposed in the K23 application, and her multidisciplinary team of mentors, will provide her with the expertise and guidance necessary to become an independent investigator in primary care smoking cessation research with underserved populations. Research Focus: Electronic health records (EHR) are increasingly being used to prompt health care providers to assess and treat tobacco use, as well as to document that these services were rendered. The United States Congress passed legislation ("meaningful use" of EHR) that could increase the use of the EHR for both assessing smoking status and providing cessation assistance in clinics serving Medicaid and Medicare patients. EHRs can aid in the ability to track the progress on selected indicators and can be utilized in research to identify important information about subpopulations that are less likely to be getting the standard of care for tobacco use treatment. Although research has shown that EHR use does increase the number of unique patients asked about smoking status, research is mixed on whether use of this technology increases rates of quitting advice or smoking cessation. The study will use quantitative data from OCHIN, a multiple-facility, linked EHR provider, and qualitative data from clinic observations and interviews with health care providers and patients. This mixed-methods study will 1) evaluate whether implementation of Stage 1 Meaningful Use of EHRs for smoking indicators, which includes changes to the EHR vital signs section, increases rates of assessing smoking status and readiness to quit, and smoking cessation assistance, 2) identify patient, provider, and clinic characteristics associated with rates of smoking assessment and delivery of cessation services, and 3) identify factors that promote and hinder smoking cessation treatment in primary care settings through clinic observations and interviews with both health care providers and patients. This research will inform the development of a primary care-based smoking cessation intervention that utilizes health information technology, as well as develop Dr. Bailey's career in primary care research focused on underserved populations. Training goals: Dr. Bailey's training goals include 1) developing an advanced understanding of facilitators and barriers to the assessment and treatment of smoking in federally-qualified health centers (FQHCs), including use of health information technology, 2) increasing her knowledge of health disparities in underserved populations, 3) developing skills in qualitative methodology and mixed methods research, including advanced biostatistical analysis. Environment: Dr. Bailey will undergo her career development in the Department of Family Medicine at Oregon Health & Science University, an organization with significant and longstanding resources for early-career researchers. She has strong institutional and departmental support. Methods: Using EHR data from 21 FQHC primary care clinics, and random effects Poisson regression, Dr. Bailey will evaluate whether implementation of Stage 1 Meaningful Use increases the rates of assessing smoking status and readiness to quit, and providing smoking cessation assistance (Aim 1). Using 2014 EHR data from 69 FQHC primary care clinics, she will conduct logistic generalized estimating equation regression analyses to examine associations between patient, provider, and clinic-level characteristics and rates of the assessment and treatment of smoking (Aim 2). Finally, using qualitative methods, she will identify facilitators and barriers to smoking cessation treatment in FQHCs. She will collect this data through patient and provider interviews and observations of clinics with the highest and lowest rates of smoking cessation assistance (Aim 3). Outcomes: These results will aid in determining whether resources being invested in the meaningful use of EHR are producing any measurable changes and how they might need to be improved. Findings from this study can inform policy and clinical practices, particularly in primary care settings that provide services to underserved populations with higher than average smoking rates. Results from this study will inform the design of a future intervention for smoking cessation in FQHCs that will be proposed in an R01 application during the latter years of the award period.

描述（由申请人提供）：候选人：Steffani Bailey博士拥有临床心理学博士学位，是俄勒冈州健康与科学大学家庭医学系的研究助理教授。贝利博士进行了基于实验室的研究渴望的过程，并指导了两个随机临床试验戒烟的社区为基础的人口。她有19篇同行评议的出版物，其中9篇是第一作者。Bailey博士以前在戒烟方面的研究经验，K23申请中提出的培训活动，以及她的多学科导师团队，将为她提供必要的专业知识和指导，使她成为服务不足人群的初级保健戒烟研究的独立研究者。研究重点：电子健康记录（EHR）越来越多地用于促使医疗保健提供者评估和治疗烟草使用，以及记录这些服务的提供。美国国会通过立法（EHR的“有意义的使用”），可以增加EHR在医疗补助和医疗保险患者诊所中评估吸烟状况和提供戒烟帮助的使用。EHR可以帮助跟踪选定指标的进展情况，并可用于研究，以确定有关不太可能 得到烟草使用治疗的标准护理。尽管研究表明，EHR的使用确实增加了询问吸烟状况的独特患者的数量，但关于使用这项技术是否会增加戒烟建议或戒烟率的研究却参差不齐。该研究将使用来自OCHIN的定量数据，OCHIN是一家多设施，链接EHR提供商，以及来自临床观察和与医疗保健提供者和患者访谈的定性数据。这项混合方法研究将：1）评估第1阶段有意义地使用电子健康记录作为吸烟指标的实施情况，包括对电子健康记录生命体征部分的更改，是否增加了评估吸烟状态和戒烟准备情况以及戒烟援助的比率，2）确定与吸烟评估和戒烟服务提供率相关的患者、提供者和诊所特征，以及3）通过临床观察和与卫生保健提供者和患者的访谈，确定促进和阻碍初级保健环境中戒烟治疗的因素。这项研究将为利用健康信息技术开发基于初级保健的戒烟干预措施提供信息，并发展Bailey博士在初级保健研究中的职业生涯，重点关注服务不足的人群。培训目标：Bailey博士的培训目标包括：1）深入了解联邦合格卫生中心（CIMCs）评估和治疗吸烟的促进因素和障碍，包括使用健康信息技术，2）增加她对服务不足人群健康差异的了解，3）发展定性方法和混合方法研究的技能，包括先进的生物统计分析。工作环境：贝利博士将在俄勒冈州健康与科学大学的家庭医学系进行职业发展，该大学为早期职业研究人员提供了重要而长期的资源。她得到了机构和部门的大力支持。研究方法：使用来自21个EHR初级保健诊所的EHR数据和随机效应泊松回归，Bailey博士将评估第1阶段有意义使用的实施是否会增加评估吸烟状态和戒烟准备的比率，并提供戒烟帮助（目标1）。使用2014年EHR数据从69个EHR初级保健诊所，她将进行逻辑广义估计方程回归分析，以检查患者，提供者和临床水平的特征和吸烟的评估和治疗率之间的关联（目标2）。最后，使用定性方法，她将确定促进者和戒烟治疗的障碍，在CNOHC。她将通过患者和提供者访谈以及观察戒烟援助率最高和最低的诊所（目标3）来收集这些数据。成果：这些结果将有助于确定投入到有意义地使用EHR的资源是否产生了任何可衡量的变化，以及如何改进这些变化。这项研究的结果可以为政策和临床实践提供信息，特别是在为吸烟率高于平均水平的服务不足人群提供服务的初级保健环境中。这项研究的结果将为未来的戒烟干预设计提供信息，该干预将在奖励期的最后几年在R01申请中提出。