Refer 2 Quit: Proactive Promotion of Tobacco Use Treatment for Underserved Household Members Who Smoke through Pediatric Primary Care

项目摘要/摘要 种族和少数民族群体以及来自低社会经济群体的人受到不成比例的 烟草营销的影响，较少获得烟草使用的循证治疗，并报告 需要为戒烟努力提供更多支持。儿科医生具有独特的地位，可以在医疗上提供帮助 在解决吸烟问题和保护儿童免受二手烟(SHS)暴露方面服务不足的家庭，但 适当的治疗很少提供给吸烟的父母。新兴临床决策支持(CDS) 电子健康记录(EHR)中的系统，包括该团队开发的系统，帮助儿科医生 筛查SHS暴露，激励父母参与治疗，并开出处方和/或将照顾者联系到 烟草干预。然而，基于办公室的方法只关注于前往诊所就诊的照顾者 他们的孩子，无法接触到更多吸烟的家庭成员，导致许多成年人无法接触到 对于循证治疗和儿童持续暴露于SHS的有害影响。因此，一名少校 保护儿童免受SHS感染和将烟草使用治疗扩大到服务不足的成年人的障碍 吸烟的人正在寻找一种有效且可扩展的方法来吸引所有吸烟的家庭成员，而不是 只有带着孩子去儿科诊所的父母。这项提议使用了创新的、多方面的 结合人口健康和临床信息学实施的学科研究方法 克服这一障碍的战略，并通过以下方式系统地扩大烟草使用治疗的范围 儿科保健机构。基于电子病历的信息学工具可以有效地识别额外的家庭 吸烟并主动提供烟草治疗的成员。使用严格的、双臂务实的随机化 在一个大型儿科网络内进行的对照试验，该网络包括高比例的医疗补助参保儿童的做法， 我们将比较一种使用人群健康和临床信息学实施的新干预方法 策略与常规护理，以增加烟草使用治疗的覆盖面、有效性和健康公平性。 我们将使用类型2混合有效性-实施设计，来衡量临床干预的影响 关于优先成果和测试执行战略。具体目标是：目标1)比较 Refer2Quit的影响范围--一项积极的、人群健康和临床信息学实施干预措施 吸烟家庭成员的烟草使用治疗参与度与日常护理；目的2)比较 Refer2戒烟干预对提高吸烟家庭成员戒烟率的效果 以及目标3)研究家庭成员和儿科患者的特征，这些特征 与Refer2Quit的覆盖范围和有效性相关。这解决了一个重大的实践差距， 烟草循证治疗的利用，特别是对未得到充分服务的人群。利用 儿科环境可以增加循证烟草治疗的获得和使用。这项提议将产生一个 可扩展的战略，以解决服务不足社区内烟草使用的影响。

Project Summary/Abstract Racial and ethnic minority groups and those from low socioeconomic groups suffer disproportionately from the effects of tobacco marketing, have less access to evidence-based treatments for tobacco use, and report needing more support for cessation efforts. Pediatricians are uniquely positioned to help medically underserved families to address smoking and protect children from secondhand smoke (SHS) exposure, but appropriate treatments are rarely delivered to parents who smoke. Emerging clinical decision support (CDS) systems within electronic health records (EHRs), including those developed by this team, help pediatricians screen for SHS exposure, motivate parent treatment engagement, and prescribe and/or connect caregivers to tobacco interventions. Office-based approaches, however, focus only on caregivers attending clinic visits with their children, failing to reach additional household members who smoke, leaving many adults without access to evidence-based treatments and children continually exposed to detrimental effects of SHS. Thus, a major barrier to protecting children from SHS exposure and extending tobacco use treatment to underserved adults who smoke is identifying an efficient and scalable method to engage all household members who smoke, not just parents who present to the pediatric clinic with the child. This proposal uses an innovative, multi- disciplinary research approach incorporating both population health and clinical informatics implementation strategies to overcome this barrier and systematically expand the reach of tobacco use treatment through pediatric healthcare settings. EHR-based informatics tools can efficiently identify additional household members who smoke and proactively offer tobacco treatment. Using a rigorous, 2-arm pragmatic randomized control trial within a large pediatric network comprising practices with high rates of Medicaid-insured children, we will compare a novel intervention using population health and clinical informatics implementation strategies vs. usual care to increase the reach, effectiveness, and health equity of tobacco use treatments. We will use a Type 2 hybrid effectiveness-implementation design, measuring the clinical intervention's impact on priority outcomes and testing an implementation strategy. The specific aims are: Aim 1) To compare the reach of Refer2Quit - a proactive, population health and clinical informatics implementation intervention on tobacco use treatment engagement for household members who smoke vs. usual care; Aim 2) To compare the effectiveness of the Refer2Quit intervention for increasing quit rates among household members who smoke vs. usual care; and Aim 3) To study household member and pediatric patient characteristics that are associated with reach and effectiveness of Refer2Quit. This addresses a significant practice gap in the utilization of evidence-based treatments for tobacco, particularly for underserved populations. Leveraging the pediatric setting can increase access and use of evidence-based tobacco treatments. This proposal will yield a scalable strategy to address the impacts of tobacco use within under-served communities.