Optimized Chronic Care for Smokers: A Comparative Effectiveness Approach

描述(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，也是癌症的首要可预防原因。医疗保健环境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，在这些环境中接受吸烟治疗的吸烟者太少，他们接受的治疗效果不够有效。该计划项目旨在通过开发和实施电子健康记录(EHR)系统来弥补这些差距，该系统可增加吸烟者接受治疗的人数，并为所有吸烟者开发和实施具有干预成分的高效慢性护理治疗。首先，将在3个医疗保健系统的18个诊所实施新的电子健康记录系统，并对其增加吸烟者参加慢性护理治疗的能力进行试验性评估(项目1)。然后，使用高效的研究方法，我们将对多种干预成分进行实验比较，当这些成分组合在一起时，将产生一种优化的治疗方案，涵盖吸烟治疗过程的所有阶段。该一揽子计划将：提高最初不愿戒烟的吸烟者的戒烟动机并使他们为戒烟做好准备(项目2)，当吸烟者准备戒烟时提高戒烟成功率并防止复发(项目3)，以及重新让吸烟者接受治疗，并在戒烟后恢复戒烟(项目4)。我们的高度集成的研究项目，在四个核心的支持下，因此将实施一个强大的新的EHR战略，以有效地招募吸烟的初级保健患者到慢性护理治疗吸烟。我们的团队在以下方面拥有独特的优势：医疗保健环境中的戒烟治疗研究、与EHR供应商和初级保健诊所建立的合作、比较有效性研究和研究方法。项目整合是通过共享的基于电子病历的招聘平台、在项目中重叠样本作为参与者在停止过程的各个阶段的过渡以及在项目之间使用共同的措施来促进的。在现实世界的诊所中进行这项工作增加了它在现实世界中应用的潜力。该计划项目的结果将促进研究方法和在医疗保健环境中成功治疗吸烟。

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.