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

项目摘要 医疗保健系统有巨大的潜力为 每年大约有2500万美国吸烟者接受初级保健，但戒烟的普及 治疗创新进展缓慢，最佳做法的实施构成重大挑战。为 治疗进展对吸烟率和与吸烟相关的发病率和 死亡率，戒烟治疗的范围必须增加；提供戒烟的患者太少了 只有5%的美国吸烟者试图戒烟时同时使用咨询和药物治疗， 推荐的戒烟治疗。这个项目寻求对因素有更深的理解。 与全面计划(全面慢性护理)的达成和实施有关 对于吸烟计划，CCCSTOP)针对吸烟的成人初级保健患者正在进行评估 计划项目。该计划旨在鼓励戒烟(对于那些最初不愿意戒烟的人)并提供帮助 那些准备戒烟的人实现了节欲。CCCSTOP的关键组成部分是：系统评估 初级保健就诊时的吸烟状况；自动将吸烟的患者转介给中央护理经理 世卫组织提供主动吸烟干预(除非患者选择戒烟)；协调药物治疗和 向初级保健提供者和州戒烟热线提供咨询；以及筛查和转介符合医疗条件的人 希望获得帮助的患者需要集中的强化药物治疗和咨询服务。海流 项目将使用由以下人员指导的评估来检查计划关键方面的影响范围和实施情况 RE-AIM规划和评估框架和PRISM评估干预-翻译的方法 背景。将收集多层次、多方法的数据以实现以下目标：1)评估覆盖范围； REACH的代表性，并在将于年主办该项目的16家诊所保持REACH 2)医疗保健系统；2)评估干预的保真度、适应性、维护性、相关性和结果 跨患者组、人员、角色和地点；以及3)检查实施的程度 与该项目中公众健康利益的关键成果有关：戒烟。要将数据 支持这些目标将从吸烟和与吸烟有关的患者的电子健康记录中收集 干预暴露；患者满意度；一线诊所工作人员和临床医生调查、访谈、 观察和绩效指标；对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；以及与诊所和系统层面的半结构化访谈 影响采用和实施决策的领导者。这项工程将跨越生态层面 (患者对系统)在两个单独的实施队列中使用混合方法。这将推进我们的 了解在实施系统的、持续的努力以扩大影响范围和 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.