Optimized Chronic Care for Smokers: A Comparative Effectiveness Approach

描述（由申请人提供）：吸烟是美国发病率和死亡率的主要可预防原因，也是癌症的主要可预防原因。医疗机构为接触吸烟者和提供有效的吸烟治疗提供了巨大的潜力。然而，在这些环境中接受戒烟治疗的吸烟者太少，而且他们接受的治疗不够有效。本项目旨在通过开发和实施电子健康记录（EHR）系统来解决这些差距，该系统增加了吸烟者接受治疗的人数，并为所有吸烟者提供了具有干预成分的高效慢性护理治疗。首先，新的电子病历系统将在3个医疗保健系统的18个诊所实施，并实验性地评估其增加吸烟者进入慢性护理治疗的能力（项目1）。然后，使用高效的研究方法，我们将通过实验比较多种干预成分，当这些成分组合在一起时，将产生一个优化的治疗方案，解决吸烟治疗过程的所有阶段。该方案将：增加最初不愿戒烟的吸烟者的戒烟动机，并为戒烟做好准备（项目2）；提高戒烟成功率，并在吸烟者准备戒烟时防止复发（项目3）；如果吸烟者复发，重新接受治疗并恢复戒烟（项目4）。我们高度整合的研究项目，在四个核心的支持下，将因此实施一个强大的新的电子病历战略，有效地招募吸烟的初级保健患者进入吸烟的慢性护理治疗。我们的团队在以下方面具有独特的优势：医疗机构的戒烟治疗研究，与电子病历供应商和初级保健诊所建立的合作关系，比较有效性研究和研究方法。通过共享的基于ehr的招聘平台，跨项目的重叠样本作为参与者在停止过程的各个阶段的过渡，以及跨项目使用共同的度量来促进项目集成。在现实世界的诊所开展这项工作增加了其在现实世界应用的潜力。这个项目的结果将促进研究方法和成功治疗吸烟在医疗机构。

DESCRIPTION (provided by applicant): Cigarette smoking is the chief preventable cause of morbidity and mortality in the US and is the leading preventable cause of cancer. Healthcare settings provide enormous potential for reaching smokers and delivering effective smoking treatments. Yet, too few smokers receive smoking treatments in these settings and the treatments they receive are not sufficiently effective. This Program Project aims to address these gaps by developing and implementing both an electronic health record (EHR) system that increases smokers' recruitment into treatment and a highly effective chronic care treatment with intervention components for all smokers. First, a new EHR system will be implemented in 18 clinics in 3 healthcare systems and experimentally evaluated on its ability to increase the recruitment of smokers into chronic care treatment (Project 1). Then, using highly efficient research methods, we will experimentally compare multiple intervention components that, when combined, will produce an optimized treatment package that addresses all phases of the smoking treatment process. The package will: increase quitting motivation among smokers initially unwilling to quit and prepare them for cessation (Project 2), enhance quitting success and prevent relapse when smokers are ready to quit (Project 3), and re-engage smokers in treatment and restore their abstinence if they have relapsed (Project 4). Our highly integrated research projects, supported by four cores, will thus implement a powerful new EHR strategy to efficiently recruit primary care patients who smoke into chronic care treatment for smoking. Our team has unique strengths in: smoking cessation treatment research in healthcare settings, established collaborations with EHR vendors and primary care clinics, comparative effectiveness research, and research methods. Project integration is fostered by a shared EHR-based recruitment platform, overlapping samples across projects as participant's transition through phases of the cessation process, and use of common measures across projects. Conducting this work in real-world clinics increases its potential for real-world application. The results of this Program Project will advance both research methods and the successful treatment of smoking in healthcare settings.