Smoking Cessation Clinical Trial
Official title:
Implementing Guidelines for Smoking Cessation: A Randomized Trial of Evidence-Based Quality Improvement
Smoking is a serious and common health risk among veterans. Given the press of national initiatives and local incentives to improve smoking cessation care in response to VA performance measures, this study tests a widely applicable approach to clinical practice guidelines implementation, namely evidence-based quality improvement, which is directly relevant to the translation of efficacious treatments into enhancements in VA health care policy and practice. Evidence-Based Quality Improvement (EBQI) focuses on improved provider adherence to smoking cessation guidelines and a decrease in patient smoking rates in a manner designed to produce short- and long-term health improvements and cost benefits at the organizational level.
Background:
Smoking is a serious and common health risk among veterans. Given the press of national
initiatives and local incentives to improve smoking cessation care in response to VA
performance measures, this study tests a widely applicable approach to clinical practice
guidelines implementation, namely evidence-based quality improvement, which is directly
relevant to the translation of efficacious treatments into enhancements in VA health care
policy and practice. Evidence-Based Quality Improvement (EBQI) focuses on improved provider
adherence to smoking cessation guidelines and a decrease in patient smoking rates in a
manner designed to produce short- and long-term health improvements and cost benefits at the
organizational level.
Objectives:
Adherence to smoking cessation guidelines requires practice changes at the patient,
provider, and system levels to achieve optimal quit rates. The objective of this study was
to evaluate the effectiveness of evidence-based quality improvement (EBQI)�an
expert-designed and locally implemented clinical reorganization of smoking cessation care�on
changes in smoking cessation (SC) practice among primary care providers and health outcomes
among veteran smokers.
Methods:
An evidence-based quality improvement intervention comprising provision of physician and
patient educational materials, local priority setting with leadership and providers, and
local adaptation of expert-designed protocols was implemented in experimental VA primary
care practices (n=9). VA control sites (n=9), matched on size and academic affiliation,
received smoking cessation guideline copies. We randomly sampled, consented, screened and
surveyed primary care patients at all 18 sites (n=1,941 smokers) and used computer-assisted
telephone interviewing to assess sociodemographics, health status, function, and smoking
behavior, attitudes and treatment experience. Post-intervention 12-month follow-up
interviews were completed using the same measures (n=1,080). We used multiple imputation
using hotdeck techniques and applied both enrollment and attrition weights to the
patient-level data. We used weighted logistic regression to evaluate intervention effects,
controlling for patient-level predictors of quit attempts and quit status (e.g., level of
addiction, readiness to change, age, health).
Status:
The project is completed. Analysis is ongoing for manuscripts.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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