Reducing Hospital Readmission Rates by Implementing an Inpatient Tobacco Cessation Service Driven by Interactive-Voice Recognition Technology

有充分的理由相信，在住院期间为患者提供戒烟服务可以改善患者的临床结果。吸烟增加了患者出现一系列不良临床结果的风险，包括治疗相关毒性和并发症、药物副作用和体能状态下降。在住院期间对患者进行干预具有几个优点。首先，病人在住院期间是不允许吸烟的，暂时戒烟可以作为一种催化剂，帮助他们在出院后保持无烟状态。第二，把病人带到医院的疾病可能会促使他们戒烟。第三，住院的吸烟者可以获得专业医疗人员的帮助和药物，以帮助戒烟。因此，联合委员会jc建议医院对所有患者进行烟草使用筛查，并在出院后一个月内提供戒烟服务和后续支持。不幸的是，很少有医院执行jc烟草治疗标准，部分原因是这些服务需要额外的费用，标准是自愿的，而且对医院和保险公司的经济利益还没有记录在案。未来，国家卫生政策的变化可能会激励医院和保险公司探索戒烟服务如何有助于控制医疗成本。例如，医疗保险和医疗补助中心将惩罚那些30天再入院率超过5种情况允许限度的医院：1例急性心肌梗塞，2例心力衰竭，3例肺炎，4例慢性阻塞性肺病和5例髋关节/膝关节置换。南卡罗来纳州医科大学最近实施了一种自动化的院内戒烟方案，该方案使用IVR技术，以根据JC标准对出院后的患者进行随访。该研究利用了适当的数据捕获机制，该机制允许医院临床系统、戒烟计划和全州范围的医疗保健利用数据集之间的有效联系，以检查医院再入院和成本结果。该研究将采用中断时间序列设计，以检查在2013年1月1日至2013年12月31日期间和2014年2月1日至2015年1月31日期间计划实施之前再入院率的每月趋势，使我们能够检验自动住院戒烟计划将减少计划外再入院和医疗保健费用的假设。这项研究提供了一种有效的方法，通过二次数据分析来检验投资戒烟服务是否可以帮助医院避免再入院处罚并降低医疗成本。

There is good reason to believe that providing tobacco cessation services to patients while hospitalized can improve clinical outcomes for patients. smoking increases a patient's risk for a host of negative clinical outcomes, including treatment-related toxicities and complications, medication side effects, and reduced performance status. intervening with patients while hospitalized offers several advantages. First, patients are not permitted to smoke while in the hospital and temporary smoking abstinence may serve as a catalyst to help them remain tobacco free after discharge. second, the illness that brought patients to the hospital may serve to motivate them to refrain smoking. third, hospitalized smokers have access to medical professionals and medications to assist in refraining smoking. thus, the joint commission jc has recommended that hospitals screen all patients for tobacco use and offer cessation services and follow up support within 1 month of discharge. Unfortunately, few hospitals implement the jc tobacco treatment standards in part because the services require extra costs, the standards are voluntary, and the financial benefits to hospitals and insurers have yet to be documented. in the future, national health policy changes may incentivize hospitals and insurers to explore how smoking cessation services may help to control healthcare costs. for example, the centers for medicare and medicaid will penalize hospitals whose 30-day readmission rates exceed allowable limits for 5 conditions: 1 acute mi, 2 heart failure, 3 pneumonia, 4 copd and 5 hip/knee replacement. the medical university of south carolina recently implemented an automated in-hospital smoking cessation program using ivr technology to follow-up with patients post-discharge in accordance with jc standards. this study takes advantage of in-place data capture mechanisms that allow efficient linkage between hospital clinical system, cessation program and statewide healthcare utilization datasets to examine hospital readmission and cost outcomes. the proposed study will use an interrupted time series design to examine monthly trends in readmission rates before 01/01/13-12/31/13 and after 02/01/14-01/31/15 program implementation, allowing us to test the hypothesis that an automated inpatient smoking cessation program will reduce unplanned readmissions and healthcare costs. this study provides an efficient way to examine whether investing in tobacco cessation services can help hospitals to avoid readmission penalties and reduce healthcare costs via secondary data analyses.