Electronic Proactive Outreach for Smokers with COPD: Engaging patients to quit

概述：我正在申请为期5年的职业发展奖(CDA)，以支持我的总体目标 在呼吸系统疾病患者中增加戒烟。这将通过 完成有指导的研究活动和旨在提供必要技能的正式培训 成为一名独立调查员。在我获奖的过程中，我将开发和测试一个程序 为患有慢性阻塞性肺疾病(COPD)的吸烟者提供积极的烟草治疗 以电子方式，旨在增加对循证烟草治疗的参与。 意义：慢性阻塞性肺疾病是退伍军人健康管理局最常见的疾病之一 90%的病例直接归因于吸烟。尽管退伍军人管理局在烟草领域取得了长足的进步 与对照组相比，COPD患者的吸烟率继续是VA总体平均水平的两倍。烟草的治疗 使用障碍是对患有COPD的吸烟者最有效的干预措施。不幸的是，患有COPD的吸烟者 烟草使用仍然得不到足够的治疗。积极主动的烟草治疗计划，吸烟者 在常规探视之外有系统地识别，进行戒烟尝试，并与证据有关- 以此为基础的治疗，已被发现对增加戒烟和戒烟支持的使用有效， 对患有慢性阻塞性肺疾病的吸烟者可能特别有益。积极主动的计划很少实施， 可能是因为相关的工作量很大。使用电子通信(如安全消息传递)来 提供这种护理可能是有效的，而不会产生与之前测试的电话相关的成本和工作量 外展计划。CDA提案中制定的干预措施具有广泛影响的潜力 影响，更有效地利用现有退伍军人管理局资源，在这一高危人群中增加戒烟。 职业生涯规划：我的主要研究领域是找出患者在护理质量上的差距 慢性阻塞性肺病，特别是在戒烟治疗中。要成功实现提高资源利用率的目标 对患有慢性阻塞性肺疾病的吸烟者进行烟草治疗，我需要在实施科学方面进行进一步的指导培训 包括：定性和混合方法、设计和测试有重点的行为烟草干预措施 关于移动健康和成本分析。我将通过正式的课程学习、研讨会和 在明尼阿波利斯弗吉尼亚州首席导师、医学博士Steven Fu的指导下进行的研究活动 医疗保健系统[MVAHCS])，Hildi Hagedorn博士(MVAHCS)和David Au，医学硕士(VA Puget Sound)。 研究计划：我的主要研究目标是开发和测试一种电子主动烟草 针对患有慢性阻塞性肺疾病的吸烟者的治疗计划。为了实现这一目标，我将完成以下项目：1)a) 混合方法(调查和访谈)评估当前卫生信息技术的使用情况 患有慢性阻塞性肺病的吸烟者(A)告知为目标量身定做的积极主动的烟草治疗计划 人口(B)评估慢性病状况与参与意向之间的联系 主动计划2)对实施主动计划的障碍和促进者进行定性评估 在员工和领导中为COPD患者提供烟草治疗计划，以(A)了解慢性病 采取积极主动的烟草治疗干预措施和(B)为今后的执行工作提供信息，3)a 通过Secure提供的针对患有COPD的吸烟者的前瞻性烟草治疗计划的随机试点 并与通常的护理进行比较，以(A)评估可行性和(B)量化该计划的成本。这个 拟议的培训和研究项目将产生未来发展所需的初步数据 研究人员发起的研究(IIR)提案在第三年提交。我计划提出一个随机比较 将本提案中开发的干预措施与之前测试的电话进行有效性比较的试验 提高戒烟率的方法，开始我作为一名独立的退伍军人事务部HSR&D调查员的职业生涯 致力于通过增加戒烟治疗的机会来改善退伍军人的健康。

Overview: I am applying for a 5-year Career Development Award (CDA) to support my overarching goal of increasing smoking cessation among patients with respiratory diseases. This will be accomplished through the completion of mentored research activities and formal training designed to provide the skills necessary to become an independent investigator. During the course of my award, I will develop and test a program of proactive tobacco treatment for smokers with chronic obstructive pulmonary disease (COPD), delivered electronically and designed to increase participation in evidence-based tobacco treatments. Significance: COPD is one of the most common conditions cared for by the Veterans Health Administration and 90% of cases are directly attributable to smoking. Though the VA has made great strides in tobacco control, patients with COPD continue to smoke at rates double the overall VA average. Treatment for tobacco use disorder is the most impactful intervention for smokers with COPD. Unfortunately, smokers with COPD remain undertreated for tobacco use. Proactive tobacco treatment programs, where smokers are systematically identified outside of a routine visit, engaged in a cessation attempt, and connected to evidence- based treatment, have been found to be effective for increasing smoking cessation and use of quit support, and may be particularly beneficial for smokers with COPD. Proactive programs are rarely implemented, possibly due to high associated workload. Using electronic communication such as secure messaging to deliver this care may be effective without the cost and workload associated with previously tested telephone outreach programs. The intervention developed in this CDA proposal has the potential for wide-reaching impact, leveraging existing VA resources more efficiently to increase cessation in this high-risk population. Career Plan: My primary area of research has focused on identifying gaps in care quality for patients with COPD, particularly in tobacco cessation treatment. To successfully achieve my goals of improving utilization of tobacco treatment for smokers with COPD, I need further mentored training in implementation science including: qualitative and mixed methods, design and testing of behavioral tobacco interventions with a focus on mobile health, and cost analysis. I will achieve these objectives through formal coursework, seminars, and mentored research activities under the guidance of Steven Fu, MD MSCE (primary mentor, Minneapolis VA Health Care System [MVAHCS]), Hildi Hagedorn, PhD (MVAHCS) and David Au, MD MS (VA Puget Sound). Research Plan: My primary research objective is to develop and test an electronic proactive tobacco treatment program for smokers with COPD. To execute this goal, I will complete the following projects: 1) a mixed methods (survey and interview) assessment of current use of health information technology among smokers with COPD to (A) inform the creation of a proactive tobacco treatment program tailored to the target population (B) assess the association between the chronic disease state and intention to engage with the proactive program 2) a qualitative assessment of barriers and facilitators to implementation of proactive tobacco treatment programs for patients with COPD among staff and leadership to (A) understand the slow adoption of proactive tobacco treatment interventions and (B) inform future implementation efforts, 3) a randomized pilot of a proactive tobacco treatment program for smokers with COPD delivered through secure messaging and compared to usual care to (A) assess feasibility and (B) quantify the cost of the program. The proposed training and research projects will generate preliminary data necessary for development of a future Investigator-Initiated Research (IIR) proposal submitted in Year 3. I plan to propose a randomized comparative effectiveness trial comparing the intervention developed in this proposal to a previously tested telephone method for increasing tobacco abstinence, launching my career as an independent VA HSR&D investigator committed to improving Veterans’ health through enhanced access to tobacco cessation treatment.