Project 4: An Analysis of Implementation of Comprehensive Chronic Care for Smokers in Primary Care (Implementation)

项目摘要 医疗保健系统具有巨大的潜力，可以为吸烟者提供基于证据的戒烟治疗。 每年大约有2500万美国吸烟者接受初级保健， 治疗创新进展缓慢，最佳做法的实施构成重大挑战。为 治疗进展对吸烟流行率和吸烟相关发病率产生重大影响， 死亡率，戒烟治疗的范围必须增加;很少有吸烟患者被提供戒烟 帮助，只有5%的美国吸烟者试图戒烟，同时使用咨询和药物治疗， 建议停止治疗。该项目旨在更深入地了解 与全面计划（全面慢性病护理）的覆盖和实施相关 吸烟计划，CCCSTOP）的成人初级保健患者吸烟，正在评估这一点， 计划项目。该计划旨在激励戒烟（在那些最初不愿意戒烟），并帮助 那些准备戒烟的人实现了禁欲。CCCSTOP的主要组成部分是： 初级保健访视时的吸烟状况;自动将吸烟患者转诊给中心护理经理 世卫组织提供积极的吸烟干预措施（除非患者选择退出）;协调药物治疗， 咨询初级保健提供者和国家退出线;和筛选和转介医疗合格 需要帮助戒烟的患者接受集中的强化药物治疗和咨询服务。当前 该项目将使用以下指导评估，检查该计划关键方面的覆盖范围和实施情况 RE-AIM规划和评估框架以及评估干预转化的PRISM方法 上下文将收集多层次、多方法的数据，以解决以下目标：1）评估范围， 覆盖范围的代表性，以及在16个将主持该项目的诊所中跨时间的覆盖范围的维持。 2个医疗保健系统; 2）评估干预保真度、适应性、维护、相关性和结局 跨患者群体、人员、角色和站点;以及3）检查实施的程度 与该项目的公共卫生利益的关键成果有关：戒烟。数据以 支持这些目标将从电子健康记录收集患者吸烟和吸烟相关 干预暴露;患者满意度评级;一线诊所工作人员和临床医生调查，访谈， 观察和绩效指标;与护理经理进行深入访谈和直接观察， 将吸引吸烟者并提供干预措施;以及与诊所和系统级的半结构化访谈 影响采用和实施决策的领导者。这个项目将跨越生态层面 （患者到系统）在2个单独的实施队列中使用混合方法。这将推动我们的 了解在系统、持续地努力扩大覆盖面方面的挑战， 戒烟治疗的有效性，从而降低与吸烟有关的发病率和死亡率。

Project Summary Healthcare systems have tremendous potential to deliver evidence-based smoking cessation treatment to the roughly 25 million US smokers who receive primary care each year, but dissemination of smoking cessation treatment innovations has been slow and implementation of best-practices poses major challenges. For treatment advances to have a substantial impact on smoking prevalence and smoking-related morbidity and mortality, the reach of cessation treatments must increase; too few patients who smoke are offered quitting assistance, and only 5% of US smokers trying to quit use both counseling and pharmacotherapy, the recommended cessation treatment. This project seeks to generate a deeper understanding of factors associated with the reach and implementation of a comprehensive program (the Comprehensive Chronic Care for Smoking Program, CCCSTOP) for adult primary care patients who smoke that is being evaluated in this Program Project. The program is designed to motivate quitting (in those not initially willing to quit) and to help those ready to quit achieve abstinence. The key components of CCCSTOP are: systematic assessment of smoking status at primary care visits; automatic referral of patients who smoke to a centralized care manager who delivers proactive smoking interventions (unless patients opt out); coordination of pharmacotherapy and counseling with primary care providers and the state quitline; and screening and referring medically eligible patients who want help quitting to centralized intensive pharmacotherapy and counseling services. The current project will examine the reach and implementation of key facets of the program using assessments guided by the RE-AIM planning and evaluation framework and the PRISM approach to assessing intervention-translation context. Multilevel, multimethod data will be collected to address the following aims: 1) to evaluate the reach, representativeness of reach, and maintenance of reach across time in the 16 clinics that will host the project in 2 healthcare systems; 2) to evaluate intervention fidelity, adaptations, maintenance, correlates, and outcomes across patient groups, personnel, roles, and sites; and 3) to examine the extent to which implementation is associated with the key outcome of public health interest in this project: abstinence from smoking. Data to support these aims will be collected from electronic health records of patient smoking and smoking-related intervention exposure; patient ratings of satisfaction; front-line clinic staff and clinician surveys, interviews, observation, and performance metrics; in-depth interviews with and direct observation of care managers who will engage smokers and deliver interventions; and semi-structured interviews with clinic- and system-level leaders who influence adoption and implementation decisions. This project will cut across ecological levels (patient to system) using mixed methods in 2 separate implementation cohorts. This will advance our understanding of challenges in implementing systematic, sustained efforts to expand the reach and effectiveness of smoking cessation treatment, and thereby reduce morbidity and mortality related to smoking.