Cigarette smoking is the leading preventable cause of death in the U.S. The 2008 US Public Health Service Smoking Cessation Guideline recommends offering effective treatment that includes both medication and counseling to smokers in all health care settings, including hospitals. Nearly 4 million smokers are hospitalized each year, and hospital admission offers a teachable moment for intervention. In-hospital smoking cessation intervention is efficacious, but only if contact continues for >1 month after discharge. The challenge is to translate this efficacy from research into clinical practice by identifying an evidence-based cost-effective model that U.S. hospitals can adopt. The major barrier is sustaining contact after discharge. This project tests an innovative strategy to efficiently sustain patient contact after discharge by streamlining the delivery of post- discharge smoking interventions in order to maximize their uptake.
Specific Aim : To test the effectiveness of an innovative strategy to increase hospitalized smokers' long-term tobacco abstinence rate by maximizing their use of evidence-based tobacco treatment (counseling and medication) after hospital discharge. Study Design: A multi-site randomized controlled comparative effectiveness trial will enroll 1350 adult smokers admitted to 3 acute care hospitals in Massachusetts and Pennsylvania. All subjects will receive a brief in-hospital smoking intervention and be randomly assigned at discharge to either Standard Care (referral to the MA or PA state quitline) or Extended Care, consisting of a 3-month program with 2 components: (1) Free Medication: A 30- day supply of FDA-approved medication (nicotine replacement, bupropion, or varenicline) given at hospital discharge and refillable free for a total of 90 days to facilitate medication use and adherence; (2) Interactive Voice Response (IVR) Triage to Telephone Counseling from a national quitline provider (Free & Clear). IVR is proactive.
It aims to encourage medication adherence and enhance counseling efficiency by identifying smokers who need post-discharge support. Immediate transfer of a patient from automated IVR call to a live telephone counselor will facilitate a successful connection to counseling. Using a national quitline provider offers efficient scaling. Outcomes, assessed at 1, 3, and 12 months after hospital discharge, are: (1) intervention effectiveness (cotinine-validated 7-day point-prevalence tobacco abstinence rate at 12 month follow-up [1o outcome] and other measures of tobacco abstinence); (2) smoking cessation treatment utilization, and (3) cost-effectiveness (cost per quit). An exploratory analysis will examine the intervention's effect on health and health care utilization (hospital readmission and mortality in the 12 months after discharge). Policy implication: Standard Care meets current Medicare and Joint Commission National Hospital Quality Measures (NHQM) for tobacco. Extended Care meets the revised tobacco NHQM that are being reviewed for adoption. This trial of Extended Care will provide strong evidence about the proposed hospital quality measure revisions and could offer U.S. hospitals an evidence-based way to comply with them.

Public Health Relevance

Cigarette smoking is the leading preventable cause of death in the U.S. Smoking cessation reduces risk and extends life expectancy. This project aims to identify a cost-effective strategy for delivering smoking cessation treatment to the nearly 4 million U.S. smokers who are hospitalized each year.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL111821-04
Application #
8791703
Study Section
Risk, Prevention and Intervention for Addictions Study Section (RPIA)
Program Officer
Stoney, Catherine
Project Start
2012-03-07
Project End
2017-01-31
Budget Start
2015-02-01
Budget End
2016-01-31
Support Year
4
Fiscal Year
2015
Total Cost
$760,563
Indirect Cost
$261,165
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Kalkhoran, Sara; Benowitz, Neal L; Rigotti, Nancy A (2018) Prevention and Treatment of Tobacco Use: JACC Health Promotion Series. J Am Coll Cardiol 72:1030-1045
Ylioja, Thomas; Cochran, Gerald; Chang, Yuchiao et al. (2017) Postdischarge smoking cessation in subgroups of hospitalized smokers: A latent class analysis. Subst Abus 38:493-497
Rigotti, Nancy A; Chang, Yuchiao; Rosenfeld, Lisa C et al. (2017) Interactive Voice Response Calls to Promote Smoking Cessation after Hospital Discharge: Pooled Analysis of Two Randomized Clinical Trials. J Gen Intern Med 32:1005-1013
Scheuermann, Taneisha S; Richter, Kimber P; Rigotti, Nancy A et al. (2017) Accuracy of self-reported smoking abstinence in clinical trials of hospital-initiated smoking interventions. Addiction 112:2227-2236
Pack, Quinn R; Priya, Aruna; Lagu, Tara C et al. (2017) Smoking Cessation Pharmacotherapy Among Smokers Hospitalized for Coronary Heart Disease. JAMA Intern Med 177:1525-1527
Kruse, Gina R; Kalkhoran, Sara; Rigotti, Nancy A (2017) Use of Electronic Cigarettes Among U.S. Adults With Medical Comorbidities. Am J Prev Med 52:798-804
Streck, Joanna M; Regan, Susan; Chang, Yuchiao et al. (2017) Examining the effects of illicit drug use on tobacco cessation outcomes in the Helping HAND 2 randomized controlled trial. Drug Alcohol Depend 178:586-592
Rigotti, Nancy A; Tindle, Hilary A; Regan, Susan et al. (2016) A Post-Discharge Smoking-Cessation Intervention for Hospital Patients: Helping Hand 2 Randomized Clinical Trial. Am J Prev Med 51:597-608
Reid, Zachary Z; Regan, Susan; Kelley, Jennifer H K et al. (2015) Comparative Effectiveness of Post-Discharge Strategies for Hospitalized Smokers: study protocol for the Helping HAND 2 randomized controlled trial. BMC Public Health 15:109
Rigotti, Nancy A; Harrington, Kathleen F; Richter, Kimber et al. (2015) Increasing prevalence of electronic cigarette use among smokers hospitalized in 5 US cities, 2010-2013. Nicotine Tob Res 17:236-44