CONNECT: COmpreheNsive traiNing and Engagement in Cessation Treatment

项目摘要 美国成年人吸烟率在全国范围内约为14%，但差异显著 持续存在，包括家庭年收入<35，000美元的成年人（21.3%），医疗补助接受者 (23.9%）和无保险者（23.9%）。这些人群也不太可能接受戒烟 协助和使用循证戒烟干预措施。许多公共卫生议程强调 解决这些不平等问题，以减少与吸烟有关的发病率和死亡率。为此，我们需要 增加这些人群获得戒烟服务的机会。社区卫生中心（CHCs） 理想的环境，以达到吸烟者谁是社会经济上处于不利地位，因为他们提供照顾29万 病人，其中大多数是没有保险或公共保险。将Quitline转介纳入这些 吸烟者有可能接触到大量的吸烟者。双向电子转诊系统，允许 提供者从电子健康记录（EHR）和戒烟热线直接向戒烟热线发送转诊， 将有关患者处置的信息发送回患者的个人EHR，提供一个平台， 更有效和标准化的转介系统。与传真相比，此方法增加了Quitline的覆盖范围 或间接转诊方法;然而，疾病控制和预防中心的目标是戒烟热线， 每年达到所有烟草使用者8%的目标尚未实现。在如何最好地 在卫生保健环境中实施Quitline电子转诊系统，以最大限度地扩大 戒烟服务。加强学术细节，包括教育推广和绩效审计 和反馈，可以增加最佳做法的使用和新流程和程序的吸收， 医疗保健提供者;然而，亲自和持续的增强学术细节很少用于 实施戒烟热线转诊。几乎一半的美国州报告没有与其供应商相关的员工培训 转介方案。这项随机分组试验将招募30名俄勒冈州CHC（n~ 15，000名吸烟患者）。 一半的诊所将随机接受Quitline电子转诊系统， 详细说明（干预条件; n=15家诊所），一半接受Quitline电子转诊系统， 增强的学术细节（比较条件; n=15个诊所）。这项务实的试验将使用电子健康记录， Quitline数据用于评估美国吸烟者的戒烟援助覆盖率和有效性 干预诊所与对照诊所患者的比率进行了比较。我们还将评估 电子转介系统的成本效益，无论有没有加强学术细节。这种可扩展 干预有很大的潜力，通过增加戒烟治疗的可及性， 州戒烟热线与社区卫生中心之间的合作，为大量社会经济弱势群体提供服务 吸烟者。这项研究解决了国家癌症研究所的研究重点，即开发有针对性的， 可扩展的干预措施，以减少这一弱势群体的吸烟。

PROJECT SUMMARY Adult smoking prevalence in the United States (US) is approximately 14% nationwide, yet significant disparities persist, including among adults with annual household incomes <$35,000 (21.3%), Medicaid recipients (23.9%), and the uninsured (23.9%). These populations are also less likely to receive smoking cessation assistance and to use evidence-based cessation interventions. Many public health agendas emphasize addressing these inequalities to reduce smoking related morbidity and mortality. To do this, we need to increase accessibility to cessation services among these populations. Community health centers (CHCs) are ideal settings to reach smokers who are socioeconomically disadvantaged as they provide care to 29 million patients, the majority of whom are uninsured or publicly insured. Integrating Quitline referrals into these settings has the potential to reach a large number of smokers. Bidirectional eReferral systems, which allow providers to send a referral directly to the Quitline from the electronic health record (EHR) and Quitlines to send information about the patient's disposition back into the patient's individual EHR, provide a platform for more efficient and standardized referral systems. This method has increasedQuitline reach compared to faxed orindirect referral methods; however,the Centers for Disease Control and Prevention's goal for Quitlines to reach 8% of all tobacco users annually has not been met. A critical knowledge gap exists in how best to implement Quitline eReferral systems into health care settings to maximize the reach and effectiveness of cessation services. Enhanced academic detailing, which includes educational outreach and performance audit and feedback, can increase the use of best practices and the uptake of new processes and procedures among health care providers; however, in-person and ongoing enhanced academic detailing is infrequently used for Quitline referral implementation. Almost half of all US states report no staff training related to their provider referral programs. This cluster-randomized trial will recruit 30 Oregon CHCs (n~15,000 patients who smoke). Half of the clinics will be randomized to receive the Quitline eReferral system with enhanced academic detailing (intervention condition; n=15 clinics) and half to receive the Quitline eReferral system without enhanced academic detailing (comparison condition; n=15 clinics). This pragmatic trial will use EHR and Quitline data to assess rates of smoking cessation assistance reach and effectiveness among patients in the intervention clinics compared with rates among patients in the comparison clinics. We will also evaluate the cost-effectiveness of the eReferral system, both with and without enhanced academic detailing. This scalable intervention has high potential to increase accessibility to smoking cessation treatment through the collaboration between state Quitlines and CHCs that serve large numbers of socioeconomically disadvantaged smokers. This study addresses the National Cancer Institute's research priority of developing targeted and scalable interventions to reduce smoking among this vulnerable population.