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

项目总结/摘要 少数种族和族裔群体以及社会经济地位低下的群体不成比例地遭受 烟草营销的影响，获得烟草使用循证治疗的机会较少，并报告 需要更多的支持来停止工作。儿科医生是唯一的定位，以帮助医疗 帮助服务不足的家庭解决吸烟问题，保护儿童免受二手烟（SHS）的危害， 吸烟的父母很少得到适当的治疗。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， 筛查SHS暴露，激励父母参与治疗，并规定和/或连接护理人员， 烟草干预。然而，基于护理的方法只关注参加诊所访问的护理人员， 他们的孩子无法接触到其他吸烟的家庭成员， 以证据为基础的治疗和儿童不断暴露于SHS的有害影响。因此，一个主要的 保护儿童免受SHS暴露和将烟草使用治疗扩展到服务不足的成年人的障碍 正在寻找一种有效且可扩展的方法，让所有吸烟的家庭成员参与进来， 只有带着孩子去儿科诊所的父母。该提案采用了创新的、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 克服这一障碍并系统地扩大烟草使用治疗范围的战略， 儿科医疗机构。基于EHR的信息学工具可以有效地识别额外的家庭 吸烟的会员，并主动提供烟草治疗。使用严格的双臂实用随机 在一个大型儿科网络中进行的对照试验，该网络包括医疗补助保险儿童比例较高的实践， 我们将比较一个新的干预使用人口健康和临床信息学的实施 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2型混合有效性-实施设计，测量临床干预的影响 优先成果和测试执行战略。具体目标是：目标1）比较 Refer 2 Quit的覆盖范围-一项主动的人口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与常规护理;目的2）比较 Refer 2 Quit干预措施提高吸烟家庭成员戒烟率的有效性 vs.目的3）研究家庭成员和儿科患者的特征， 与Refer 2 Quit的覆盖范围和有效性相关。这解决了在实践中的一个重大差距， 利用循证烟草治疗，特别是对得不到充分服务的人群。借力 儿科环境可以增加循证烟草治疗的获得和使用。这项建议将产生一个 可扩展的战略，以解决烟草使用在服务不足的社区的影响。

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.