PROJECT 2

项目2

• 批准号: 10661348
• 负责人: Alicia K Matthews
• 金额: $ 50.33万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-31 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10661348
• 关键词: Address; Adult; Awareness; Behavioral; Cancer Control; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Clinical Trials Design; Counseling; Education; Educational Materials; Electronic Health Record; Enrollment; Family health status; Federally Qualified Health Center; Future; Goals; Health; Healthcare; Height; Individual; Infrastructure; Intake; Link; Low Income Population; Low income; Malignant Neoplasms; Measures; Methods; Mission; Neighborhoods; New York; Participant; Patient Education; Patients; Pattern; Persons; Pharmacotherapy; Population; Population Intervention; Poverty; Poverty Areas; Professional counselor; Provider; Randomized; Recommendation; Reporting; Risk Factors; Screening for cancer; Self Determination; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Tobacco; Tobacco Use Cessation; Tobacco use; Uninsured; Vulnerable Populations; active control group; arm; compare effectiveness; cost; effectiveness evaluation; health care delivery; health disparity; health inequalities; health information technology; implementation evaluation; implementation strategy; improved; innovation; modifiable risk; nicotine patch; novel strategies; outreach; patient navigation; patient oriented; patient portal; population based; primary outcome; public health priorities; quitline; randomized trial; randomized, clinical trials; reduce tobacco use; safety net; screening; smoking cessation; smoking prevalence; social; social capital; telephone coaching; theories

Although smoking rates are declining, they remain elevated among individuals impacted by poverty (36%). Tobacco use remains an important modifiable risk factor for cancer and an urgent public health priority. Despite elevated smoking rates, low-income smokers have less awareness of, access to, and utilization of smoking cessation treatments. Federally Qualified Health Centers (FQHCs), safety-net care settings for the most vulnerable populations, represent an important yet under-appreciated opportunity for reducing smoking- related health inequalities. In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), received care at an FQHC. Innovation is needed to increase access to smoking cessation treatments among low-income smokers treated in FQHC practices serving PPA patients. Evidence shows that provider screening, counseling, and pharmacotherapy reduces tobacco use. However, consistent delivery of provider-led cessation treatments in clinical settings is challenging. State tobacco quitlines are effective, free or low-cost, and available in all states. Nevertheless, quitline usage is limited. The Centers for Disease Control recommends proactive strategies for increasing quitline use, including partnerships with health care centers. Electronic health record-linked patient portals are becoming a standard part of health care delivery and are a novel approach for proactively linking smokers to Quitlines. Evidence supports the reach and feasibility of portals for offering population-based interventions. However, prior studies have not tested implementation strategies for using portals to offer proactive linkage to quitlines. Informed by Social Determination Theory, Project 2 will evaluate the implementation of three scalable strategies, including (1) patient navigation, (2) widely available health information technology (HIT) infrastructure including the patient portal, for offering proactive linkage of low-income smokers and (3) the New York State Smoker's Quit Line (NYSSQL). We propose a population-based randomized trial in three FQHCs in SoCa neighborhoods. First, we will examine the effectiveness of an educational campaign paired with patient navigation for increasing patient portal enrollment (Aim 1). Next, we will evaluate the reach of the patient portal as an approach to delivering population-level advice to quit and smoking cessation treatment linkage (Aim 2). We will compare impact of referral type (opt-in referral vs. self-referral) on linkage to the NYSSQL (Aim 3). Aim 4 will compare the influence of message type (Arm 1 Choice vs. Arm 2 No-Choice in cessation goals) on rates of linkage to the NYSSQL and receipt of smoking cessation treatment. This project aligns with the SoCa mission of addressing health disparities in persistent poverty areas by improving health through tobacco cessation and overall portal health enrollment for future cancer screening outreach and cancer control measures.

尽管吸烟率正在下降，但在受贫困影响的个体中，它们仍然升高（36％）。 烟草使用仍然是癌症和紧急公共卫生优先事项的重要修改风险因素。 尽管吸烟率升高，但低收入吸烟者对使用，使用和利用的认识较少 戒烟治疗。联邦资格卫生中心（FQHC），安全网护理设置 大多数脆弱的人口是减少吸烟的重要机会但被低估的机会 相关的健康不平等。 2012年，大多数没有保险的患者（36％）或 公开保险（49％），在FQHC获得护理。需要创新以增加吸烟的机会 在为PPA患者的FQHC实践中治疗的低收入吸烟者的戒烟治疗。 有证据表明，提供者筛查，咨询和药物疗法减少了烟草的使用。 但是，在临床环境中以提供商为主导的戒烟治疗的持续交付具有挑战性。状态 烟草戒烟是有效的，免费的或低成本的，并且在所有州都可以使用。但是，戒烟线的用法是 有限的。疾病控制中心建议采取积极的策略来增加戒烟线的使用，包括 与医疗保健中心的合作伙伴关系。电子健康记录连接的患者门户正在成为标准 医疗保健提供的一部分，是一种新颖的方法，可以主动将吸烟者与戒烟者联系起来。证据 支持门户网站提供基于人群的干预措施的覆盖范围和可行性。但是，先前的研究 尚未测试使用门户网站提供积极联系与戒烟线的实施策略。 通过社会确定理论得知，项目2将评估三个可扩展的实施 策略，包括（1）患者导航，（2）广泛可用的健康信息技术（HIT） 包括患者门户在内的基础设施，用于提供低收入吸烟者的主动连接和（3）新的 约克州吸烟者戒烟线（NYSSQL）。我们在三个FQHC中提出了基于人群的随机试验 SOCA社区。首先，我们将研究与患者配对的教育运动的有效性 导航增加患者门户入学率（AIM 1）。接下来，我们将评估患者门户的范围 作为提供人口级建议以退出和戒烟治疗联系的方法（AIM 2）。 我们将比较转介类型（选择转介与自我推荐）与NYSSQL链接（AIM 3）的影响。目的 4将比较消息类型的影响（ARM 1选择与ARM 2在戒烟目标中无选择）的影响 与NYSSQL的联系和戒烟治疗的接收。该项目与SOCA保持一致 通过烟草改善健康，解决持续贫困地区的健康差异的使命 停止和整体门户健康入学率，用于未来的癌症筛查外展和癌症控制 措施。