Computerized EMR-Assisted Smoking Cessation (CEASCE)

描述(申请人提供)：背景：在美国，烟草是可预防的死亡的主要原因。美国公共卫生服务(PHS)敦促医生遵循帮助患者戒烟的5A：1)询问烟草使用情况；2)建议患者戒烟；3)评估戒烟意愿；4)协助戒烟尝试；5)安排戒烟尝试后的随访。研究表明，记录烟草使用(ASK)的比率很高，但后续步骤的记录比率很低。电子病历(EMR)辅助的咨询和转诊通过提供一种结构化的方法来遵守指南，有可能加强对需要烟草治疗的患者的护理。PBRN：布里格姆和妇女初级保健实践研究网络(BWPC-PBRN)由19个实践和95名主治医生组成，他们服务于不同的患者群体。BWPC诊所在组织上和电子上与一个共同的EMR相连，该EMR允许将诊断、处方和其他临床数据联系起来。2002年，BWPC-PBRN总共有237,530名患者就诊。10%的成年患者是经常吸烟的人。研究计划：我们建议开发和评估一种基于EMR的新的、量身定做的干预措施，以增加戒烟咨询，在BWPC-PBRN中使用RE-AIM(REACH，Efficiency，Adption，Implementation，Maintenance)理论模型，采用“5A”方法。具体目标1是制定一项以电子病历为基础的治疗烟草使用的战略，即电脑化电子病历辅助戒烟努力(CEASCE)。CEASCE将提供记录吸烟状况的提醒、记录5A的简单、模板化的机制、轻松获得戒烟药物，以及“一键”转介给戒烟顾问。具体目标2是通过在BWPC-PBRN中进行一项随机对照试验，以确定其在增加接受治疗的吸烟者比例方面的有效性，以评估CEASCE的覆盖范围和有效性。主要的结果是在烟草治疗中的一个关键的“辅助”：与戒烟顾问的电话联系。次要结果包括其他5A步骤的衡量标准：记录吸烟状况的患者比例(ASK)，接受戒烟建议的吸烟者比例(建议)，被问及是否愿意戒烟的吸烟者比例(评估)，以及接受戒烟药物治疗的吸烟者比例(ASSIST)。具体目标3是通过衡量使用CEASCE的提供者的比例和特征、提供者使用CEASCE各组成部分的一致性以及CEASCE的使用随时间的变化来评估CEASCs的采用、实施和短期维护(“AIM”)情况。未来方向：评估CEASCE是否可以作为其他需要行为改变咨询的常见初级保健问题的原型。

DESCRIPTION (provided by applicant): Background: Tobacco is the leading cause of preventable death in the United States. The United States Public Health Service (PHS) urges physicians to follow the "5As" to help patients quit smoking: 1) Ask about tobacco use; 2) Advise patients to quit; 3) Assess willingness to quit; 4) Assist in quit attempt; and, 5) Arrange follow-up after the quit attempt. Studies have shown high rates of documenting tobacco use (Ask), but low rates for later steps. Electronic medical record (EMR)-assisted counseling and referral has the potential to enhance the care of patients in need of tobacco treatment by providing a structured approach to guideline adherence. The PBRN: The Brigham and Women's Primary Care Practice-Based Research Network (BWPC-PBRN) consists of 19 practices with 95 attending physicians who serve a diverse patient population. BWPC Clinics are linked organizationally and electronically with a common EMR that allows linkage of diagnostic, prescribing, and other clinical data. The BWPC-PBRN had 237,530 total patient visits in 2002. Ten percent of adult patients are active smokers. Research Plan: We propose to develop and evaluate a novel, tailored EMR-based intervention to increase smoking cessation counseling utilizing the "5A" approach in the BWPC-PBRN using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) theoretical model. Specific Aim 1 is to develop an EMR-based strategy for treating tobacco use, the Computerized EMR-Assisted Smoking Cessation Effort (CEASCE). CEASCE will provide reminders to document smoking status, a simple, templated mechanism for documentation of the 5As, easy access to smoking cessation medications, and 'one-click" referral to a smoking cessation counselor. Specific Aim 2 is to assess the Reach and Effectiveness ("RE") of CEASCE, by conducting a randomized controlled trial in the BWPC-PBRN to determine its effectiveness in increasing the proportion of smokers who receive treatment. The primary outcome is a key "Assist" in tobacco treatment: telephone contact with a smoking cessation counselor. Secondary outcomes include measures of other 5A steps: the proportion of patients for whom smoking status is documented (Ask), the proportion of smokers who receive advice to quit (Advise), the proportion of smokers asked about their willingness to quit (Assess), and the proportion of smokers who receive smoking cessation medication (Assist). Specific Aim 3 is to assess the Adoption, Implementation, and short-term Maintenance ("AIM") of CEASCE by measuring the proportion and characteristics of providers who use CEASCE, the consistency with which providers use the components of CEASCE, and changes in the use of CEASCE over time. Future Directions: Evaluate whether CEASCE can serve as a prototype for other common primary care problems that require counseling for behavior change.