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

概述：我正在申请5年职业发展奖（CDA），以支持我的总体目标， 增加呼吸道疾病患者的戒烟率。这将通过以下方式实现： 完成指导研究活动和正式培训，以提供必要的技能， 成为独立调查员。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， 电子化，旨在增加循证烟草治疗的参与。 意义：COPD是退伍军人健康管理局关注的最常见疾病之一 90%的病例直接归因于吸烟。虽然退伍军人事务部在烟草业取得了长足的进步 在对照组中，COPD患者继续吸烟的比率是总体VA平均值的两倍。烟草治疗 使用障碍是对COPD吸烟者最有效的干预措施。不幸的是，患有COPD的吸烟者 烟草使用方面的治疗仍然不足。积极主动的烟草治疗计划， 在常规访问之外系统地识别，参与戒烟尝试，并与证据有关- 基于治疗，已发现有效增加戒烟和使用戒烟支持， 并且可能对患有COPD的吸烟者特别有益。积极主动的方案很少得到实施， 这可能是由于相关的工作量很大。使用电子通信，如安全消息传递， 提供这种护理可能是有效的，而没有与先前测试的电话相关的成本和工作量 外展计划本CDA提案中开发的干预措施具有广泛影响的潜力， 影响，更有效地利用现有的VA资源，以增加这一高风险人群的戒烟率。 职业规划：我的主要研究领域集中在确定患者护理质量的差距， COPD，特别是在戒烟治疗中。为了成功地实现提高 对于COPD吸烟者的烟草治疗，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，设计和测试行为烟草干预措施，重点是 关于移动的健康和成本分析。我将通过正式的课程，研讨会， 在Steven Fu，MD MSCE（主要导师，弗吉尼亚州明尼阿波利斯）的指导下指导研究活动 医疗保健系统[MVAHCS]），Hildi哈格多恩，博士（MVAHCS）和大卫Au，医学博士MS（VA普吉特湾）。 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 吸烟者COPD的治疗方案为了实现这一目标，我将完成以下项目：1） 混合方法（调查和访谈）评估目前使用卫生信息技术的情况， COPD吸烟者（A）告知创建针对目标的主动烟草治疗计划 人群（B）评估慢性疾病状态与参与社区活动的意图之间的关联。 2）对实施积极主动的障碍和促进因素进行定性评估 吸烟治疗方案对COPD患者的工作人员和领导（一）了解慢 采取积极的烟草治疗干预措施，以及（B）为今后的实施工作提供信息，3）a 一项通过安全的吸烟者治疗COPD的前瞻性烟草治疗计划的随机试点研究 消息传递并与常规护理进行比较，以（A）评估可行性和（B）量化该计划的成本。的 拟议的培训和研究项目将产生未来发展所需的初步数据， 研究者发起的研究（IIR）提案在第3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先前测试的电话进行比较的有效性试验 增加戒烟的方法，开始了我作为独立的VA HSR&D调查员的职业生涯 致力于通过增加获得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.