Leveraging the National Cancer Institute’s Cancer Center Cessation Initiative (C3I) Program to Evaluate and Transform Smoking Cessation Treatment in Cancer Care

利用国家癌症研究所的癌症中心戒烟倡议 (C3I) 计划来评估和转变癌症护理中的戒烟治疗

• 批准号: 10707958
• 负责人: MICHAEL C FIORE
• 金额: $ 91.43万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2029-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707958
• 关键词: Acceleration; Adult; Cancer Center; Cancer Etiology; Cancer Patient; Cancer Prognosis; Cancer Survivor; Caring; Data; Effectiveness; Electronic Health Record; Equity; Health; Health Care Costs; Intervention; Malignant Neoplasms; Methods; Modification; NCI-Designated Cancer Center; National Cancer Institute; Oncology; Outcome; Patients; Policies; Primary Care; Principal Investigator; Program Effectiveness; Recovery; Research; Senior Scientist; Smoke; Smoking; Smoking Cessation Intervention; Smoking treatment; System; Treatment outcome; cancer care; cancer therapy; cigarette smoking; clinical care; contextual factors; cost; cost effectiveness; demographics; design; evidence base; experience; implementation context; implementation strategy; improved; intervention delivery; patient engagement; pragmatic implementation; programs; smoking cessation; tool; treatment program

PROJECT SUMMARY/ABSTRACT Cigarette smoking is both common and undertreated among oncology patients. Although smoking is a leading cause of cancer and results in worse cancer prognoses, only half of cancer patients who smoke are offered help in quitting during cancer care, and it is unclear that the help they are offered is effective. This R35 proposal is designed to transform oncology practice so that smoking cessation is an integral part of treatment for all cancer patients who smoke. Electronic health records (EHRs) have tremendous potential to accelerate improvements in clinical care by facilitating such treatment delivery. EHR modifications can also increase discovery by enhancing assessment of smoking treatment reach, costs, equity, and effectiveness both in terms of helping patients quit and improving cancer outcomes. The Principal Investigator has 30 years of experience leading research and policy efforts to promote the treatment of smoking. Over the past 7 years, he has led a team that developed and evaluated new EHR-based tools and workflows that markedly increase the proportion of adult patients who receive evidence-based smoking cessation treatment in primary care. The new R35 proposal will similarly identify intervention strategies that increase smoking treatment engagement and effectiveness when implemented in oncologic care. Over the last 4 years, the Principal Investigator has served as Senior Scientist for NCI’s Moonshot-supported Cancer Center Cessation Initiative (C3I), a nationwide effort of 52 NCI-designated cancer centers to develop and implement programs to aid their patients who smoke. Yet, this incredibly important initiative has not been systematically assessed in terms of which EHR-enabled interventions enhance a smoking program’s reach, patient engagement, implementation, cessation effectiveness, and benefits. This R35 renewal is designed to do just that by systematically assessing best practices via EHR data extraction of intervention delivery, healthcare costs, short-term cancer treatment outcomes overall, and by patient demographics. These EHR data will be supplemented by qualitative analysis of C3I smoking treatment components, delivery, adaptations, and contexts in a mixed-methods approach. Higher- and lower-performing smoking treatment programs will be identified and rigorous methods will then be used to select best practice programs from cessation- and cost-effectiveness perspectives. Further assessment will identify implementation strategies and contextual factors that may contribute to the effectiveness of these programs. Best practices from these programs will be implemented in lower-performing C3I programs, with research team support in adaptation and implementation. Pragmatic implementation guides and strategies will be used to disseminate best practices to cancer care programs nationwide. Thus, the proposed project seeks to extend and adapt transformative EHR-facilitated system changes that enhance smoking treatment in primary care to the high-priority cancer care context. The project will demonstrate the benefits of such system changes to cancer patients in terms of costs, smoking cessation, and cancer recovery.

项目摘要/摘要 吸烟在肿瘤患者中很常见，也没有得到足够的治疗。尽管吸烟是一种 导致癌症的原因并导致更差的癌症预后，只有一半的癌症患者吸烟 在癌症护理期间帮助他们戒烟，目前还不清楚向他们提供的帮助是否有效。这款R35 该提案旨在改变肿瘤学实践，使戒烟成为治疗不可或缺的一部分 适用于所有吸烟的癌症患者。电子健康记录(EHR)具有巨大的加速潜力 通过促进这种治疗的提供，改善临床护理。电子病历修改也可以增加 通过加强对吸烟治疗范围、成本、公平性和有效性的评估来发现 帮助患者戒烟并改善癌症预后。首席调查员有30年的经验 领导研究和政策努力，促进吸烟的治疗。在过去的7年里，他领导了一个 开发和评估基于EHR的新工具和工作流的团队，这些工具和工作流显著提高了 在初级保健中接受循证戒烟治疗的成年患者的比例。新款R35 提案将同样确定增加吸烟治疗参与度和 在肿瘤护理中实施时的有效性。在过去的4年里，首席调查员 作为NCI的月球支持的癌症中心停止行动(C3I)的高级科学家，这是一项全国性的努力 在NCI指定的52个癌症中心中，制定和实施帮助吸烟患者的计划。然而， 这一极其重要的倡议尚未得到系统评估， 干预措施加强了吸烟计划的覆盖范围、患者参与度、实施和戒烟 有效性和效益。此次R35续订旨在通过系统评估最佳 通过EHR数据提取干预交付、医疗保健成本、短期癌症治疗的实践 总体结果，并按患者人口统计进行分析。这些电子健康记录数据将得到定性分析的补充 采用混合方法对C3I吸烟治疗的组成部分、交付、适应和背景进行评估。 将确定较高和较差的吸烟治疗方案，然后将制定严格的方法 用于从戒烟和成本效益角度选择最佳实践方案。进一步 评估将确定执行战略和可能有助于 这些计划的有效性。这些计划的最佳实践将在业绩较差的地区实施 C3i计划，在适应和实施方面得到研究团队的支持。务实实施指南 并将使用战略将最佳做法传播到全国癌症护理项目中。因此， 拟议的项目寻求扩展和适应由电子病历推动的变革性系统变革，以增强 将初级保健中的吸烟治疗转移到高度优先的癌症护理背景下。该项目将展示 这种系统改变在成本、戒烟和癌症康复方面给癌症患者带来的好处。

项目成果

Closed-Loop Electronic Referral From Primary Care Clinics to a State Tobacco Cessation Quitline: Effects Using Real-World Implementation Training.

• DOI: 10.1016/j.amepre.2019.12.026
• 发表时间: 2021-03
• 期刊: American journal of preventive medicine
• 影响因子: 5.5
• 作者: Baker TB;Berg KM;Adsit RT;Skora AD;Swedlund MP;Zehner ME;McCarthy DE;Glasgow RE;Fiore MC
• 通讯作者: Fiore MC

A comprehensive electronic health record-enabled smoking treatment program: Evaluating reach and effectiveness in primary care in a multiple baseline design.

• DOI: 10.1016/j.ypmed.2022.107101
• 发表时间: 2022-12
• 期刊: PREVENTIVE MEDICINE
• 影响因子: 5.1
• 作者: McCarthy, Danielle E.;Baker, Timothy B.;Zehner, Mark E.;Adsit, Robert T.;Kim, Nayoung;Zwaga, Deejay;Coates, Katherine;Wallenkamp, Hannah;Nolan, Margaret;Steiner, Margaret;Skora, Amy;Kastman, Christian;Fiore, Michael C.
• 通讯作者: Fiore, Michael C.

Electronic health record closed-loop referral ("eReferral") to a state tobacco quitline: a retrospective case study of primary care implementation challenges and adaptations.

• DOI: 10.1186/s43058-022-00357-4
• 发表时间: 2022-10-08
• 期刊: Implementation science communications

Utilization of the Electronic Health Record to Improve Provision of Smoking Cessation Resources for Vascular Surgery Inpatients.

利用电子健康记录改善血管外科住院患者的戒烟资源提供。

• DOI: 10.4172/2324-8602.1000231
• 发表时间: 2015
• 期刊: International journal of cardiovascular research
• 作者: Smith,BrigitteK;Adsit,RobertT;Jorenby,DouglasE;Matsumura,JonS;Fiore,MichaelC
• 通讯作者: Fiore,MichaelC

Don't Wait for COPD to Treat Tobacco Use.

不要等到慢性阻塞性肺病才开始治疗烟草使用。

• DOI: 10.1016/j.chest.2015.09.024
• 发表时间: 2016
• 期刊: Chest
• 影响因子: 9.6
• 作者: Fiore,MichaelC;Jorenby,DouglasE;Baker,TimothyB
• 通讯作者: Baker,TimothyB