Emergency Departments (EDs) are a critical component of the U.S. healthcare system, receiving over 119 million visits annually. While EDs have historically neglected tobacco control efforts, recent work by our research team and others shows that ED-initiated tobacco treatment is feasible, effective, and reaches historically under-served populations. National task forces have recommended implementation of ED-based tobacco screening, brief counseling and referral to specialized tobacco treatment for those interested in quitting. However, in clinical practice, delivery of tobacco interventions in the ED is inconsistent at best, non- existent at worst. We propose a translational study to institute tobacco treatment following the US PHS guidelines into existing electronic medical tracking software that is widely used across the United States. We will adapt an existing Emergency Department Information System (EDIS) to facilitate the identification of smokers, prompt physician intervention, enhance the provision of smoking cessation intervention materials as discharge instructions, facilitate quit-smoking medication prescription and advice, and connect the patient to follow up care through their primary care provider and a pro-active telephone quit line. Because this is a comprehensive, systems-based approach to patient care for tobacco cessation, it holds important implications not only for the ED setting but for other inpatient and outpatient settings as well We begin with recruitment of a baseline control cohort (Step one, Care-as-Usual). Following this, we will train ED nurses and physicians in the identification and treatment of smokers and obtain their feedback on proposed changes to the EDIS for tobacco treatment. We will then implement adaptations to the EDIS system including;smoking status tracking, treatment prompts, treatment and prescribing option panels for the ED physician, and patient discharge instructions for quitting smoking. We will also add follow-up care by automating links to primary-care follow-up and a pro-active phone counseling service. After full implementation of the EDIS system we will recruit a second patient cohort to examine the impact/efficacy and cost/efficacy of the system. Contemporaneous with the Step 1 and Step 2 cohorts, we will recruit two cohorts of smoking patients at a second (no intervention) ED site to control for historical trends. This study is a comprehensive systems-based translation of empirically supported tobacco treatment built upon a widely used patient tracking platform that maximizes the probability for a sustained, disseminable application of this intervention approach. By incorporating tobacco identification and treatment into the tracking software used at thousands of hospitals across the country, this research has a high likelihood of both translation into other settings and sustainability.
This project is a comprehensive, translational research study that will integrate the process of tobacco treatment into an electronic medical tracking system that is currently used in our emergency department and in hundreds of hospitals nation-wide. This proposal targets a heavily used medical outlet (emergency departments) and takes a systems-approach to developing sustainability. Full dissemination of this intervention would reach millions of smokers each year.
