Electronic Pediatric Office Systems to Support Treatment for Parental Tobacco Use

项目摘要/摘要 当父母戒烟时，他们的预期寿命平均增加10年以上，未来烟草- 相关的不良妊娠结局被消除，他们的孩子成年的几率要低得多 吸烟者及其子女可能不再暴露于高水平的烟草烟雾中，从而降低患上 感染烟草烟雾暴露引起的疾病，导致缺课天数减少。助人 父母和家庭成员戒烟还改善了家庭的经济来源，减少了 发育迟缓的风险，并降低房屋火灾的风险。吸烟的父母通常是医学上的 服务不足，去看孩子的医疗保健提供者的次数比看自己的临床医生还多，如果他们甚至 喝一杯吧。尽管这是一个非同寻常的干预机会，但儿童保健环境提供了有效的 对父母进行烟草依赖治疗的时间不到2%。定期将控烟工作交付给 在儿童保健环境中的父母将有益于国家的整体健康。建议的目标是 研究是为了确保每一位吸烟或同时使用烟草和电子烟的父母 并拜访他们孩子的医生，接受基于证据的戒烟帮助。我们建议测试和 儿科实践中的创新eHR系统平台(IEHR)。IEHR将促进普遍筛查 用于家庭烟草使用和例行提供，并在需要时提供戒烟服务。我们会 将这种干预与iEHR+Navigator进行比较，以测试社区额外支持的有效性 健康导航员。导航员将与儿科办公室合作，帮助家庭烟草使用者戒烟 通过电话跟踪，确保获得服务，并根据他们想要帮助的内容进行家访 他们戒烟了。这项试验将解决尚未回答的关键问题，如有效性、可持续性和 支持提供戒烟服务的父母戒烟干预措施的成本效益 使用iEHR的服务，带或不带导航器。这项提议与NCI的目标完全一致 资助研究，通过改善以下方面来减轻患者和其他受影响人群的癌症负担 与癌症相关的早期检测、预防、医疗保健提供、生活质量和/或生存。目标是： A1.为了比较父母戒烟的比率和采取无烟行为的情况， 两个干预臂(1°：iEHR+Navigator vs.iEHR；2°：每个干预vs.通常护理对照组) A2.要确定两个干预组与常规护理对照组的每次戒烟增量成本 A3.评估干预措施的交付和可持续性 在过去试验成功的基础上，这项应用将评估一种创新的与电子健康记录相关的烟草 戒烟干预针对有无导航器支持的家庭烟草使用。这个 研究旨在产生完全整合、经济高效、可传播和可持续的战略，以 在全国儿童保健环境中优化父母戒烟结果。

Project Summary/Abstract When parents quit smoking, their life expectancy is increased by an average of over 10 years, future tobacco- related poor pregnancy outcomes are eliminated, their children have much lower odds of becoming adult smokers, and their children may no longer be exposed to high levels of tobacco smoke, decreasing the odds of contracting diseases caused by tobacco smoke exposure and resulting in fewer missed school days. Helping parents and household members quit smoking also improves the financial resources of families, decreases the risk of developmental delays, and lowers the risk of house fires. Parents who smoke are often medically underserved, visiting their child's healthcare provider more often than they see their own clinician, if they even have one. Despite this extraordinary opportunity for intervention, child healthcare settings deliver effective tobacco dependence treatment to parents less than 2% of the time. Routinely delivered tobacco control to parents in child healthcare settings would benefit the overall health of the nation. The goal of the proposed study is to ensure that every parent who smokes tobacco or is a dual user of tobacco and e-cigarettes and visits their child's doctor receives evidence-based assistance to quit. We propose testing an innovative EHR systems platform (iEHR) in pediatric practices. The iEHR will facilitate universal screening for household tobacco use and routine offering and provision, if desired, of tobacco cessation services. We will compare this intervention to iEHR + navigator to test the effectiveness of additional support by a community health navigator. The navigator will work with pediatric offices to assist household tobacco users in cessation through telephone follow-up, ensuring access to services, and home visits, based on what they want to help them quit smoking. This trial will address critical unanswered questions of effectiveness, sustainability, and cost-effectiveness of a parental tobacco cessation intervention that supports delivery of tobacco cessation services using iEHR, with or without a navigator. This proposal is in exact alignment with NCI's objective to fund research to reduce the burden of cancer for patients and other affected persons through improvements in early detection, prevention, healthcare delivery, quality of life, and/or survivorship related to cancer. Aims are: A1. To compare parents' combusted tobacco quit rates, and adoption of tobacco free behaviors between the two intervention arms (1°: iEHR+Navigator vs. iEHR; 2°: each intervention vs. usual care control) A2. To establish the incremental cost per quit of the two intervention arms vs. usual care control A3. To assess the delivery and sustainability of the interventions Building on the success of past trials, this application will evaluate an innovative EHR-linked tobacco cessation intervention addressing household tobacco use with and without navigator support. The study is designed to yield fully-integrated, cost-effective, disseminable, and sustainable strategies to optimize parental cessation outcomes throughout child healthcare settings nationally.