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

描述(申请人提供)：候选人：Steffani Bailey博士，临床心理学博士，俄勒冈健康与科学大学家庭医学系研究助理教授。贝利博士对渴望过程进行了基于实验室的研究，并指导了两项针对社区人群戒烟的随机临床试验。她有19本同行评议的出版物，其中9本是第一作者。Bailey博士以前在戒烟方面的研究经验、K23申请中建议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调查者。研究重点：电子健康记录(EHR)越来越多地被用来促使卫生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情况。美国国会通过立法(“有意义地使用”电子健康记录)，可增加电子健康记录在评估吸烟状况和在为医疗补助和医疗保险患者提供戒烟帮助的诊所中的使用。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 获得烟草使用治疗的标准护理。尽管研究表明，使用电子健康记录确实会增加被问及吸烟状况的独特患者的数量，但对于使用这项技术是否会增加戒烟建议或戒烟率，研究结果喜忧参半。这项研究将使用OCHIN的定量数据，以及临床观察和对卫生保健提供者和患者的采访的定性数据。OCHIN是一家多机构、有联系的EHR提供商。这项混合方法研究将1)评估实施阶段1是否有意义地使用EHR作为吸烟指标，包括改变EHR生命体征部分，增加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比率相关的患者、提供者和临床特征；3)通过临床观察和对卫生保健提供者和患者的采访，确定在初级保健环境中促进和阻碍戒烟治疗的因素。这项研究将为利用健康信息技术开发以初级保健为基础的戒烟干预措施提供信息，并发展贝利博士在初级保健研究方面的职业生涯，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)加深对联邦合格健康中心(FQHC)评估和治疗吸烟的促进者和障碍的深入了解，包括使用医疗信息技术；2)增加她对服务不足人群健康差距的了解；3)培养定性方法和混合方法研究的技能，包括高级生物统计分析。环境：贝利博士将在俄勒冈健康与科学大学家庭医学系进行她的职业发展，该组织为职业生涯早期的研究人员提供了大量而长期的资源。她拥有强大的机构和部门支持。方法：使用21家FQHC初级保健诊所的EHR数据和随机效应泊松回归，贝利博士将评估第一阶段有意义使用的实施是否增加了评估吸烟状况和戒烟准备以及提供戒烟帮助的比率(目标1)。使用来自69家FQHC初级保健诊所的2014年EHR数据，她将进行Logistic广义估计方程回归分析，以检查患者、提供者和临床水平特征与吸烟评估和治疗比率之间的关联(目标2)。最后，使用定性方法，她将确定FQHC戒烟治疗的促进者和障碍。她将通过患者和提供者的访谈以及对戒烟辅助率最高和最低的诊所的观察来收集这些数据(目标3)。结果：这些结果将有助于确定在有意义地使用电子病历方面投入的资源是否产生了任何可衡量的变化，以及它们可能需要如何改进。这项研究的结果可以为政策和临床实践提供参考，特别是在向吸烟率高于平均水平的服务不足的人群提供服务的初级保健环境中。这项研究的结果将为设计未来在FQHC中戒烟的干预措施提供参考，该干预措施将在获奖期的最后几年在R01申请中提出。

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.