Background: Nurse-administered cessation interventions have been shown to be efficacious, but are seldom implemented due to lack of training and time. Dr. Duffy has developed, tested, and refined the efficacious, nurse-administered Tobacco Tactics intervention and has packaged it into a Toolkit for dissemination in two Veterans Affairs (VA) hospitals. However, rigorous testing of dissemination outside of the VA is needed. Objectives: Using 6 community hospitals in the Trinity Health System, the objectives of this study are to: 1)Determine provider and patient receptivity, barriers, and facilitators to implementing the nurse-administered, inpatient Tobacco Tactics intervention versus nurse referral to the 1-800-QUIT-NOW telephone line using face-to-face feedback and surveys. 2) Compare the effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus nurse referral to the 1-800-QUIT-NOW telephone line across hospitals, units, and patient characteristics using biochemically confirmed 7-day point-prevalence abstinence at 1-year cessation as the primary outcome. 3) Determine the cost-effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus nurse referral to the 1-800-QUIT-NOW telephone line including the cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. Methods: This effectiveness study will be a pre- post- quasi-experimental design in 6 Michigan community hospitals of which 3 will get the nurse-administered Tobacco Tactics intervention and the other 3 will get nurse referral to the 1-800-QUIT-NOW telephone line. A research nurse will disseminate the respective interventions in the 6 sites to Master Trainers who will teach staff nurses on all shifts on all 58 units, until all of the approximately 3,553 staff nurses are trained. Research nurses will also conduct rolling evaluation to identify barriers and facilitators to dissemination and implement measures to ensure sustainability of the intervention. It is expected that 7,868 inpatient smokers per year will be eligible to receive the intervention of which we expect to recruit 2,350 for this study to have sufficient power to analyze the objectives. Descriptive statistics (means and frequency distributions) will be used to summarize the nurses'survey results, participation rates, smokers'receipt of specific cessation services, and satisfaction with services. Logistic regressions and t-tests will be used to determine differences between intervention groups on satisfaction and quit rates, respectively, with adjustment for the clustering of patients within units and hospitals. Regression analyses will test the moderation of the effects of the interventions by patient characteristics such as confidence in ability to quit, nicotine addiction, alcohol intake, depression, demographics and a smoking related diagnosis such as heart disease. Cost-effectiveness will be assessed by constructing 3 ratios including the cost per quitter, cost per life-year saved, and the cost per quality- adjusted life-year saved.
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