Smoking Interventions for Hospital Patients:A Comparative Effectiveness Trial

针对医院患者的吸烟干预措施：比较有效性试验

• 批准号: 7937743
• 负责人: NANCY A RIGOTTI
• 金额: $ 49.67万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7937743
• 关键词: Abstinence; Address; Adherence; Admission activity; Adopted; Adult; Ambulatory Care; Area; Beds; Boston; Bupropion; Cardiovascular Diseases; Caring; Cause of Death; Chronic Obstructive Airway Disease; Clinical Research; Cost Effectiveness Analysis; Cotinine; Counseling; Disease; Enrollment; Ensure; FDA approved; General Hospitals; Grant; Guidelines; Health; Healthcare; Hospitals; Inpatients; Intervention; Intervention Studies; Joint Commission on Accreditation of Healthcare Organizations; Leadership; Massachusetts; Measures; Medicare; Medication Management; Modeling; Outcome; Patient Discharge; Patients; Pharmaceutical Preparations; Pharmacotherapy; Pneumonia; Population; Prevalence; Principal Investigator; Professional counselor; Proxy; Randomized; Randomized Controlled Trials; Reporting; Research; Research Infrastructure; Risk; Saliva; Sampling; Smoker; Smoking; Smoking Cessation Intervention; Surveys; Teaching Hospitals; Technology; Telephone; Testing; Time; Tobacco; Translating; Treatment Efficacy; United States Public Health Service; Withholding Treatment; abstracting; arm; base; cigarette smoking; clinical practice; comparative effectiveness; cost; cost effectiveness; effective intervention; effective therapy; effectiveness trial; efficacy research; evidence base; follow-up; high risk; improved; innovation; meetings; mortality; nicotine replacement; primary outcome; programs; smoking cessation; smoking intervention; standard care; tobacco abstinence; treatment as usual; varenicline; voice recognition

DESCRIPTION (provided by applicant): Smoking Interventions for Hospital Patients: A Comparative Effectiveness Trial Project Summary/Abstract The Challenge: This application addresses broad Challenge Area (04), Clinical Research, and specific Challenge Topic, 04-HL-116: Cost-effective strategies to achieve smoking cessation in hospitalized patients with cardiovascular disease and COPD. Cigarette smoking is the leading preventable cause of death in the U.S. The 2008 U.S. Public Health Service Smoking Cessation Guideline recommends offering effective treatment to smokers in every health care setting. A hospital admission provides an opportunity for a smoker to quit. Smoking cessation counseling provided in the hospital is effective, but only if it continues for >1 month after discharge. Smoking cessation medications add benefit to counseling but are not often used. The current challenge is to translate this efficacy research into routine clinical practice. The major barrier is to make the transition from inpatient to outpatient care. National Hospital Quality Measures (NHQM) now report whether a tobacco intervention is provided to hospitalized smokers with CVD, COPD, or pneumonia, but the necessary post-discharge contact is not required. An evidence-based, cost-effective intervention model that can be adopted by U.S. hospitals is needed to realize the potential impact of hospital smoking interventions. Research Plan: The Specific Aim is to conduct a randomized controlled comparative effectiveness trial of two strategies to promote smoking cessation in hospitalized patients: (1) a hospital-only intervention that meets NHQM quality standards ("Standard Care"), and (2) an "Enhanced Care" model that will facilitate the sustained use of smoking counseling and medication after discharge to produce long-term abstinence. It will include 3 months of telephone counseling after discharge and feature 2 innovations. First, to increase medication use, smokers willing to make a quit attempt will receive a free 30-day sample of their choice of FDA-approved smoking cessation medication at hospital discharge. Second, to increase counseling cost-effectiveness, we will use interactive voice recognition (IVR) technology. It will make automated telephone calls to identify the smokers most likely to benefit from continued counseling after discharge. The trial will enroll 330 adult smokers admitted to Massachusetts General Hospital, a 900-bed teaching hospital. Outcomes will be measured 1 and 6 months after hospital discharge. Study hypotheses are that the enhanced care arm, compared to usual care, is feasible and will increase (1) the use of smoking cessation treatment after discharge, (2) the duration of post-discharge tobacco abstinence, and (3) validated tobacco abstinence 6 months after hospital discharge (primary outcome). The cost-effectiveness (cost per quit) of the interventions will be also be compared. Potential Impact: Nearly 4 million U.S. smokers are hospitalized each year, many of them at high risk for tobacco-related mortality due to CVD or COPD. This project could identify a way to translate an effective smoking cessation intervention into routine hospital practice and thereby increase the reach and impact of tobacco treatment. It could also provide evidence to support a revised NHQM hospital quality measure. Project Relevance Cigarette smoking is the leading preventable cause of death in the U.S. Smoking cessation reduces health risks. Being hospitalized provides a smoker a good opportunity to quit smoking. This project will test two strategies for providing assistance, using both smoking cessation counseling and pharmacotherapy, to help hospitalized smokers stop smoking after hospital discharge.

描述（由申请人提供）：医院患者的吸烟干预措施：比较有效性试验项目摘要/摘要挑战：该申请应解决广泛的挑战领域（04），临床研究和特定挑战主题，04-HL-116：成本效益的策略：在患有心血管疾病和COPD的住院患者中实现戒烟的策略。吸烟是美国的主要可预防原因，2008年美国公共卫生服务戒烟指南建议在每个医疗保健环境中为吸烟者提供有效的治疗方法。医院入院为吸烟者提供了机会。医院提供的戒烟咨询是有效的，但前提是出院后持续> 1个月。戒烟药物为咨询带来了好处，但不经常使用。当前的挑战是将这项功效研究转化为常规临床实践。主要的障碍是从住院到门诊护理的过渡。国家医院质量措施（NHQM）现在报告是否向患有CVD，COPD或肺炎的住院吸烟者提供了烟草干预，但不需要必要的入院后接触。需要美国医院可以采用的一种基于证据的，具有成本效益的干预模型，以实现医院吸烟干预措施的潜在影响。研究计划：具体目的是对两种策略进行随机对照比较有效性试验，以促进住院患者的戒烟：（1）仅医院干预符合NHQM质量标准（“标准护理”），以及（2）一种“增强的护理”模型，该模型可促进持续使用后的吸烟咨询和在出院后的长期使用，以实现长期的替代使用。它将包括出院后3个月的电话咨询和2个创新。首先，为了增加药物使用，愿意进行戒烟尝试的吸烟者将获得30天的免费样本，以便在出院时选择FDA批准的戒烟药物。其次，为了提高咨询成本效益，我们将使用交互式语音识别（IVR）技术。它将进行自动电话，以确定最有可能在出院后继续咨询中受益的吸烟者。该试验将招收330名成年吸烟者，该吸烟者被送往马萨诸塞州综合医院，这是一家900张床位的教学医院。出院后1和6个月，结果将测量。研究假设是，与通常的护理相比，增强的护理臂是可行的，并且会增加（1）出院后使用戒烟治疗，（（2）入院后烟草的戒烟持续时间；（3）已验证的烟草保制在住院后6个月（原发性结果）。还将比较干预措施的成本效益（每次退出成本）。潜在的影响：每年有近400万美国吸烟者住院，其中许多人因CVD或COPD而患烟草有关的死亡率高。该项目可以确定一种将有效的戒烟干预措施转化为常规医院实践的方法，从而增加烟草治疗的影响力和影响。它还可以提供证据以支持经修订的NHQM医院质量措施。项目相关性吸烟是美国戒烟的主要预防死亡原因可降低健康风险。住院提供了一个吸烟者，是戒烟的好机会。该项目将测试两种策略，以提供援助，同时使用戒烟咨询和药物治疗，以帮助住院后的吸烟者在出院后停止吸烟。