Engaging Healthcare Practice Teams and Patients in Tobacco Cessation Intervention

每年有超过3000万美国吸烟者访问初级保健临床医生。因此，医疗保健 组织，包括医疗保健提供系统和一线实践团队， 通过促进吸烟者使用循证戒烟治疗，帮助他们成功戒烟。的 2000年公共卫生服务临床实践指南治疗烟草使用和依赖包括 基于证据的5-A（询问，建议，评估，协助，安排）算法，供提供者解决烟草问题 依赖和帮助吸烟者戒烟使用已证实的治疗（Fiore等人，2000年）。然而，2005年 国家健康访谈调查（NHIS）表明，在49%的尝试戒烟的吸烟者中， 每年，不到5%的人使用经证实的行为治疗，不到1/3的人使用药物辅助， 不到4%的人使用了行为和药物联合干预的金标准（咖喱et 例如，2007年）。一个假设是，5-A算法的复杂性和时间需求可能会阻碍 提供者在医疗保健访问期间解决烟草使用问题，而更简单的两步（询问和行动） 这种方法可能会增加提供者的建议和帮助，因此， 吸烟者的治疗使用（Schroeder，2005）。这项研究直接在社区中验证了这一假设- 基层医疗机构设置。具体目的是：（1）确定电子合同的效力 病历（EMR）提示5-A和2-A临床实践算法。使用三臂组 随机试验，这两种算法将相互比较，并与无EMR提示对照进行比较 条件初级保健实践团队包括随机分组和分析单位。结果 衡量指标是吸烟者接受行为干预和药物治疗的比例 由从EMR、提供者自我报告、患者自我报告和患者自我报告中获得的纵向数据确定。 威斯康星州戒烟热线。（2）测试某些实践团队特征是否起调节或中介作用 临床算法的有效性。(3)估计与EMR相关的患者水平结局 提示，包括使用行为或药物干预，戒烟和持续 禁欲(4)估计5-A和2-A临床算法的成本-效果， 每次治疗的利用率。 相关性（参见说明）： 很少有吸烟者使用经过验证的戒烟治疗方法来帮助他们戒烟。拟建项目 旨在为医疗保健实践团队确定最有效的临床策略，以帮助他们 患者戒烟的援助，证明干预措施和测试电子病历（EMR） 提示（提醒）作为实施循证临床指南的一种方式。

More than 30 million American smokers visit a primary care clinician each year. As a result, health care organizations, including health care delivery systems and front-line practice teams are uniquely positioned to help smokers successfully quit by facilitating their use of evidence-based tobacco cessation treatments. The 2000 Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence includes an evidence-based 5-A (Ask,Advise, Assess, Assist, Arrange) algorithm for providers to address tobacco dependence and help smokers to quit using proven treatments (Fiore et al., 2000). However, the 2005 National Health Interview Survey (NHIS) indicates that, among the 49% of smokers who attempt cessation each year, fewer than 5% used proven behavioral treatment, less than 1/3 used pharmacological aids, and fewer than 4% used the gold standard of combined behavioral and pharmacological interventions (Curry et al., 2007). One hypothesis is that the complexity and time demands of the 5-A algorithm may discourage providers from addressing tobacco use during health care visits and that a simpler two-step (Ask and Act) approach may increase provider advice and assistance and, consequently, rates of evidence-based treatment use among smokers (Schroeder, 2005). This study directly tests this hypothesis in community- based primary care practice settings. The specific aims are: (1) To determine the effectiveness of electronic medical record (EMR) prompting for the 5-A and 2-A clinical practice algorithms. Using a three-arm group randomized trial, the two algorithms will be compared to each other and to a no-EMR prompt control condition. Primary care practice teams comprise the unit of randomization and analysis. Outcome measures are rates of referral of smokers to behavioral interventions and pharmacotherapy treatments determined by longitudinal data obtained from the EMR, provider self-reports, patient self-reports, and the Wisconsin Tobacco Quit Line. (2 To test whether certain practice team characteristics moderate or mediate the effectiveness of the clinical algorithms. (3) To estimate patient-level outcomes associated with EMR prompting, including use of behavioral or pharmacological interventions, smoking cessation and sustained abstinence. (4) To estimate the cost-effectiveness of the 5-A and 2-A clinical algorithms with reagrd to cost- per-treatment utilization. RELEVANCE (See instructions): Too few smokers use proven cessation treatments to help them quit smoking. The proposed project is designed to identify the most effective clinical strategy for health care practice teams to use to help their patients quit smoking with the aid of proven interventions and to test electronic medical record (EMR) prompting (reminders) as a way to implement evidence-based clinical guidelines.