Implementation and Health Systems Integration Core

该项目旨在制定一种综合治疗方法，使所有到医疗机构就诊的吸烟者都能有效地接受治疗，帮助他们戒烟。这将通过以下方式实现：1)制定吸烟者招募策略，用于现实世界的初级保健诊所，该策略基于电子健康记录（EHR）的增强；2)制定吸烟的慢性护理治疗，该治疗在吸烟治疗的所有阶段都有效：增强戒烟动机，帮助戒烟，预防复发，帮助复发恢复。建议的研究将使用强大的研究方法，要求在多个关联的实验中测试多个干预成分。因此，拟议的研究需要支持有效修改电子病历的实施策略，在医疗保健环境中进行研究，以及在吸烟治疗的不同阶段对吸烟者进行多种干预成分的准确传递和评估。实施和卫生系统整合核心将通过实现以下四个具体目标来支持这四个拟议的研究项目：1)支持开发和实施电子病历，增强吸烟状况的记录，并为到现实世界初级保健诊所就诊的吸烟者提供吸烟治疗的转诊。2)调整、实施和维护计算机化数据库，以提示和跟踪干预措施，并确保研究人员对本计划项目申请中描述的所有四个项目进行适当的研究干预和评估；3)培训所有研究人员进行所有研究干预和评估，并监测其能力和对研究方案的忠实度；4)支持综合招聘战略，以实现项目2-4的招聘目标（在24个月内，来自三个医疗保健系统的18个初级保健诊所的1712人）。核心研究人员和工作人员在修改电子病历、在医疗保健环境中开展研究以及对吸烟治疗进行雄心勃勃的比较有效性研究方面的丰富经验，将有助于实现这些目标。这一核心将确保拟议的工作以高效和及时的方式进行。

This Program Project aims to develop a comprehensive treatment approach that engages all smokers visiting healthcare settings in treatment that efficiently and effectively helps them stop smoking. This will be achieved by: 1) developing a smoker recruitment strategy to be used in real-world primary care clinics that is based on enhancements to the electronic health record (EHR), and 2) by developing a chronic care treatment for smoking that is effective across all phases of smoking treatment: enhancing quitting motivation, aiding cessation, preventing relapse, and aiding relapse recovery. The proposed research will use powerful research methods that call for testing multiple intervention components in multiple linked experiments. Thus, the proposed research requires implementation strategies that support effective modification of the EHR, the conduct of studies in healthcare settings, and the accurate delivery and evaluation of multiple intervention components with smokers at different phases of smoking treatment. The Implementation and Health Systems Integration Core will support the four proposed research projects by achieving four specific aims: 1) To support the development and implementation of an EHR enhanced to increase the documentation of smoking status and referral to smoking treatment for smokers visiting real-world primary care clinics. 2) To adapt, implement, and maintain a computerized database to prompt and track interventions and to ensure that research staff administer the appropriate study interventions and assessments for all four projects described in this Program Project application; 3) To train all research staff to conduct all study interventions and assessments and to monitor competency and fidelity to study protocols; and 4) To support an integrated recruitment strategy to meet the recruitment goals for Projects 2-4 (N=1712 from 18 primary care clinics in three healthcare systems over 24 months). The achievement of these aims will be enhanced by the extensive prior experience of the Core investigators and staff in modifying EHRs, conducting research in healthcare settings, and conducting ambitious comparative effectiveness research on smoking treatments. This Core will ensure that the proposed work is conducted in a highly effective and timely manner.