ASSIST: Assessment of Medicaid policy on Smoking Cessation Assistance and Surgical Outcomes

ASSIST：评估有关戒烟援助和手术结果的医疗补助政策

• 批准号: 10797988
• 负责人: Steffani R Bailey
• 金额: $ 64.48万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-25 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10797988
• 关键词: Abstinence; Address; Adoption; Adult; Arthroscopy; Cardiovascular system; Cigarette; Data; Development; Disparity; Economically Deprived Population; Effectiveness; Electronic Health Record; Evaluation; Goals; Guidelines; Health; Health Personnel; Healthcare; Healthcare Systems; Hospitals; Insurance; Interview; Knee; Knowledge; Lead; Link; Medicaid; Methods; National Institute on Minority Health and Health Disparities; Neighborhood Health Center; Operative Surgical Procedures; Oregon; Orthopedic Surgery; Orthopedics; Outcome; Patients; Perception; Perioperative; Policies; Policy Maker; Population; Postoperative Period; Privatization; Protocols documentation; Quasi-experiment; Reduce health disparities; Reporting; Rotator Cuff; Smoking; Structure; Surgeon; Surgical complication; Surveys; Time; United States; Visit; Wound Infection; care coordination; design; experience; improved; innovation; interest; low socioeconomic status; medically necessary care; non-smoker; payment; primary care clinician; programs; repaired; smoking cessation; smoking prevalence; socioeconomic disadvantage; surgery outcome; surgical disparities; wound healing

PROJECT SUMMARY Smoking is associated with a variety of adverse health effects, including increased postoperative wound healing time, wound infections, and cardiovascular complications among surgery patients. The associations between pre-operative smoking cessation and improved surgical outcomes have led surgeons and hospitals to implement policies that require patients to quit smoking prior to elective surgeries. Given the high rate of smoking among socioeconomically disadvantaged populations and the even higher rate among Medicaid- insured surgery patients, these policies will disproportionately impact patients of lower socioeconomic status (SES). In 2017, Oregon implemented the first statewide policy in the United States that requires Medicaid- insured patients to quit smoking prior to a broad range of elective surgeries as a condition of payment for surgery by the state Medicaid program. This policy creates an opportune time to assist patients in quitting smoking pre-surgery (i.e., a “teachable moment”) and to support continued abstinence during post-operative visits; thus, this policy could result in higher rates of cessation assistance and cessation among patients of lower SES, potentially mitigating long-standing smoking-related disparities and providing support for implementation of similar policies among payers and health care systems. That said, some suggest that if patients do not receive cessation assistance and are denied surgery because they were unable to quit, these policies will exacerbate already existing smoking- and surgery-related disparities among those who are socioeconomically disadvantaged. The impact of these policies on smoking- and surgery-related outcomes among patients of lower SES are unknown. To address this knowledge gap, we will conduct a quasi- experimental study using a sequential mixed methods design. We will link electronic health record (EHR) data to Medicaid claims from 148 Oregon community health centers (CHCs) to examine changes in smoking- (cessation assistance and quit rates) and surgery- (rates of surgery and surgery complications) related outcomes among patients seeking elective orthopedic surgeries between 1/1/2014-12/31/2016 (pre-policy) and 1/1/2017-12/31/2019 (post-policy implementation). Informed by our quantitative analyses, we will conduct semi-structured interviews with health care leaders, primary care clinicians, orthopedic surgeons, and patients, and survey Care Coordination Organization leaders to explore organizational workflows and protocols related to this policy (e.g., increased cessation assistance), and perceptions and experiences of the policy on intended and unintended consequences. This innovative study will provide rigorous, actionable evidence to inform states and policy makers of the extent to which this policy results in the desired changes.

项目摘要 吸烟与多种不良健康影响有关，包括增加术后伤口 愈合时间、伤口感染和心血管并发症。的关联 手术前戒烟和改善手术结果之间的联系使外科医生和医院 实施要求患者在择期手术前戒烟的政策。鉴于高比率的 社会经济弱势群体中的吸烟率和医疗补助中的吸烟率甚至更高， 这些政策将不成比例地影响社会经济地位较低的患者 （SES）。2017年，俄勒冈州实施了美国第一个要求医疗补助的全州政策- 投保的病人戒烟之前，广泛的选择性手术作为支付的条件， 州医疗补助计划的外科手术。这项政策创造了一个适当的时间来帮助病人戒烟 手术前吸烟（即，一个“可教的时刻”），并支持在手术后继续禁欲 因此，这项政策可能会导致更高的戒烟援助率和患者的戒烟率。 较低的社会经济地位，可能减轻长期存在的吸烟相关的差距，并提供支持， 在支付者和卫生保健系统中实施类似的政策。也就是说，有人认为，如果 病人没有得到戒烟援助，并拒绝手术，因为他们无法戒烟，这些 这些政策将加剧吸烟和手术相关的不平等， 在社会经济上处于不利地位。这些政策对吸烟和手术相关结果的影响 低SES患者中的情况尚不清楚。为了解决这一知识差距，我们将进行一次准- 实验研究采用序贯混合方法设计。我们将电子健康记录（EHR）数据 来自148个俄勒冈州社区卫生中心（CHC）的医疗补助申请，以检查吸烟的变化- （戒烟援助和戒烟率）和手术-（手术率和手术并发症）相关 2014年1月1日至2016年12月31日（政策前）寻求择期骨科手术的患者的结局， 1/1/2017-12/31/2019（政策实施后）。根据我们的定量分析，我们将进行 与卫生保健领导人、初级保健临床医生、整形外科医生和患者进行半结构化访谈， 并调查护理协调组织领导人，以探索组织工作流程和相关协议 对于该策略（例如，增加戒烟援助），以及对打算戒烟的政策的看法和经验。 和意想不到的后果这项创新的研究将提供严格的，可操作的证据， 国家和决策者了解这一政策在多大程度上导致了预期的变化。