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

 说明(由申请人提供)：有充分的理由相信，在住院期间向患者提供戒烟服务可以改善患者的临床结果。吸烟会增加患者出现一系列负面临床结果的风险，包括与治疗相关的毒性和并发症、药物副作用和表现状态下降。在住院期间对患者进行干预有几个好处。首先，患者在医院期间不允许吸烟，临时戒烟可能会成为帮助他们出院后保持无烟的催化剂。其次，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医疗专业人员和药物的帮助，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1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，部分原因是服务需要额外费用，标准是自愿的，医院和保险公司的经济利益尚未记录在案。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30天再住院率超过5种情况允许限度的医院：1)急性心肌梗死，2)心力衰竭，3)肺炎，4)慢性阻塞性肺病和5)髋关节/膝盖置换。南卡罗来纳医科大学最近实施了一项自动化的医院内戒烟计划，使用的结果可能不会推广到其他医院。 按JC标准对患者出院后进行随访。这项研究利用就地数据捕获机制，允许医院临床系统、戒烟计划和全州医疗保健利用数据集之间的有效联系，以检查医院再次入院和成本结果。这项拟议的研究将使用中断的时间序列设计来检查计划实施前(01/01/13-12/31/13)和计划实施后(02/01/14-01/31/15)再住院率的每月趋势，使我们能够测试自动住院戒烟计划将减少计划外再入院和医疗成本的假设。这项研究提供了一种有效的方法来检查投资于戒烟服务是否可以帮助医院避免再次入院处罚，并通过辅助数据分析降低医疗成本。

 DESCRIPTION (provided by applicant): 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 from smoking. Third, hospitalized smokers have access to medical professionals and medications to assist in refraining from 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 Results may not be generalized to other hospital settings. 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.