Tobacco use is responsible for over 440,000 preventable deaths in the United States each year, and is a primary risk factor for lung and other cancers, chronic lung disease, heart disease, and stroke. Interventions to reduce tobacco use are highly effective and cost-effective compared to other commonly-provided preventive services and are considered the gold standard for preventive services. Extensive smoking cessation follow-up after hospital discharge significantly increases abstinence. Yet, efforts have largely been unsuccessful at integrating treatment into healthcare and sustaining treatment once the research ended. The failure of hospital initiated tobacco dependence treatment to effectively integrate into health care and bring about increased rates of tobacco cessation is a lost opportunity, especially for patients suffering from conditions for which immediate and sustained tobacco cessation can save lives. The goal of this patient-randomized effectiveness trial is to demonstrate that an inpatient technology supported assisted referral (l-TSAR) and follow-up approach is an effective and cost-effective method to help hospitalized patients successfully quit smoking. The proposed study represents a unique opportunity to assess the effectiveness and cost-effectiveness of linking inpatient and outpatient delivery of smoking cessation services in two large and very different health care delivery systems. We will enroll 900 participants (600 intervention, 300 controls) over 15-months and collect follow-up survey and health care utilization data over 12 months to estimate: 1) smoking abstinence at 6 and 12 months for l-TSAR intervention recipients compared to usual care;2) the dose effect on smoking abstinence at 6 and 12 months for l-TSAR recipients compared to usual care;3) total and mean costs per participant for l-TSAR and usual care recipients, and, if effective, estimate the incremental cost-effectiveness of the intervention vs. controls at 12 months from health plan/insurer and societal perspectives;and 4) differences in health care utilization at 12 months for l-TSAR versus controls. This innovative study will provide important evidence for the effectiveness and cost effectiveness of technologically supporting hospital staff efforts to provide treatment assistance to smokers interested in quitting and arrange for telephone follow-up support. Testing the approach in two different health care systems will provide generalized data for other health plans and insurers about the value of using electronic medical records systems to help inpatient staff facilitate smoking cessation treatment after discharge.
