Reducing Tobacco Use Disparities Among Adults in Safety Net Community Health Centers

据估计，2600万吸烟者在初级保健期间仍未因吸烟而得到治疗。 鉴于长期存在的解决吸烟问题的临床系统、提供者和患者障碍，尤其是在 贫困人口，EHR-连接医疗保健系统的自动化人口健康管理方法 有了临床和电子社区服务，所有吸烟者都可以更多地获得 有效的治疗。对于服务不足的低收入吸烟者来说，更多的机会尤其重要 并背负着与烟草相关的疾病不成比例的负担。虽然90%的吸烟者还没有准备好戒烟， 许多人对减少吸烟感兴趣，而吸烟的减少增加了未来戒烟尝试和 戒烟。基于自决理论，以人为中心的人口外展针对低收入和 并为他们提供戒烟或戒烟的选择，作为戒烟的第一步 提高他们对治疗的参与度和使用率以及实现戒断的可能性。这个2人组 随机对照试验将评估以人为中心的人群健康管理的有效性 低收入吸烟者戒烟干预研究。参与者将有530人，来自不同的低收入家庭 芝加哥一家大型联邦合格健康中心(FQHC)的吸烟者使用其电子健康识别 记录(EHR)系统。通过EHR系统自动执行，参与者将收到一封代表其 如果还没有准备好，鼓励戒烟或减少吸烟作为戒烟的第一步的提供者 设置退出日期(选择更改；N=265)。这封信将与两个自动文本/语音配对 每隔三天发送的消息，旨在加强信件的中心消息传递(选择 改变并制定自己的目标“)。信件邮寄两周后，参与者将收到来自 伊利诺伊州烟草公司提供免费的以人为本的行为咨询和免费尼古丁 替代疗法(NRT；贴片、口香糖或含片)。治疗将继续作为接受或启动 参与者为期26周。治疗结果将直接从Quitline服务器传输到EHR 系统。选择更改将与常规护理(N=265)进行比较，在通常护理中，转诊为主动 Quitline治疗是在诊所就诊期间进行的。主要的研究结果将是治疗参与度。 (初始咨询呼叫已完成)在6周时，利用率(已完成一个或多个额外咨询呼叫)在 12周和26周时停止吸烟(Bioverized7天点流行戒烟)。探索性的 研究的目的将是检查干预效果的主持人。我们假设选择改变将 增加吸烟者参与和使用治疗并实现戒烟的比例，如 与常规护理相比。电子健康记录--自动化的、以人为中心的人群健康管理干预 这是通过理论和患者反馈并针对低收入吸烟者提供的信息，可以减少严重的 在获得、利用和停止治疗方面的差异。如果被确定为有效，则选择改变 干预可以传播到全美的FQHC和州戒烟热线。

An estimated 26 million smokers still receive no treatment for their smoking during their primary care visits. Given the persistent clinical system, provider, and patient barriers to addressing smoking, especially among poor populations, an EHR-automated population health management approach that links a healthcare system with community services both clinically and electronically to engage all smokers may increase access to effective treatment. Increased access is especially significant for low-income smokers who are underserved and carry a disproportionate burden of tobacco-related disease. While 90% of smokers are not ready to quit, many are interested in cutting down, and smoking reduction increases the likelihood of future quit attempts and smoking cessation. Based on self-determination theory, person-centered population outreach that targets low- income smokers and offers them the choice to either quit or cut down as a first step towards cessation may increase their engagement in and utilization of treatment and likelihood of achieving abstinence. This 2-group randomized controlled trial will evaluate the effectiveness of a person-centered population health management intervention for smoking cessation in low-income smokers. Participants will be 530 diverse, low-income smokers of a large Federally Qualified Health Center (FQHC) in Chicago identified using its electronic health record (EHR) system. Automated via the EHR system, participants will be mailed a letter on behalf of their providers that encourages smoking cessation or smoking reduction as a first step to cessation if not ready to set a quit date (Choose to Change; N=265). The letter will be paired with two automated text/voices messages three days apart that are designed to reinforce the central messaging of the letter (“Choose to change and make your own goal”). Two weeks after letter mailing, participants will receive a call from the Illinois Tobacco Quitline and be offered free person-centered behavioral counseling and free nicotine replacement therapy (NRT; patch, gum, or lozenge). Treatment will continue as either accepted or initiated by participants for 26 weeks. Treatment outcomes will be transmitted directly from the Quitline server to the EHR system. Choose to Change will be compared with Usual Care (N=265), in which a referral for proactive Quitline treatment is made during a clinic visit. The primary study outcomes will be treatment engagement (initial counseling call completed) at 6 weeks, utilization (one or more additional counseling calls completed) at 12 weeks, and smoking cessation (bioverified 7-day point-prevalence abstinence) at 26 weeks. An exploratory study aim will be to examine moderators of intervention effects. We hypothesize that Choose to Change will increase the proportion of smokers who engage in and utilize treatment and who achieve cessation, as compared with Usual Care. An EHR-automated, person-centered, population health management intervention that is informed by both theory and patient feedback and targeted to low-income smokers could reduce critical disparities in treatment access, utilization, and cessation. If determined to be effective, the Choose to Change intervention could be disseminated to FQHCs and state quitlines throughout the United States.