Implementation and Health Systems Integration Core

该计划项目旨在开发一种全面的治疗方法，使所有到医疗保健机构就诊的吸烟者都能接受治疗，从而有效地帮助他们戒烟。这将通过以下方式实现：1)开发一种用于现实世界初级保健诊所的吸烟者招募战略，该战略基于电子健康记录(EHR)的增强；以及2)通过开发一种在吸烟治疗的所有阶段都有效的吸烟慢性护理疗法：增强戒烟动机、帮助戒烟、防止复发和帮助复发恢复。这项拟议的研究将使用强大的研究方法，呼吁在多个关联实验中测试多个干预成分。因此，拟议的研究需要实施战略，以支持有效修改《电子健康记录》，在医疗保健环境中进行研究，并在吸烟治疗的不同阶段准确提供和评估多种干预成分。实施和卫生系统集成核心将支持四个拟议的研究项目，以实现四个具体目标：1)支持制定和实施电子健康记录，以增加吸烟状况的文件记录，并为前往现实世界初级保健诊所的吸烟者转介吸烟治疗。2)调整、实施和维护一个计算机化数据库，以及时跟踪干预措施，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，并监测研究方案的能力和忠诚度；以及4)支持综合招聘战略，以实现项目2-4的招募目标(N=1712，来自三个医疗保健系统的18个初级保健诊所，为期24个月)。核心调查员和工作人员在修改EHR、在医疗保健环境中进行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促进这些目标的实现。该核心将确保以高效和及时的方式开展拟议工作。

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.