There is good reason to believe that providing tobacco cessation services to patients while hospitalized can improve clinical outcomes for patients. Smoking increases a patient's risk for a host of negative clinical outcomes, including treatment-related toxicities and complications, medication side effects, and reduced performance status. Intervening with patients while hospitalized offers several advantages. First, patients are not permitted to smoke while in the hospital and temporary smoking abstinence may serve as a catalyst to help them remain tobacco free after discharge. Second, the illness that brought patients to the hospital may serve to motivate them to refrain from smoking. Third, hospitalized smokers have access to medical professionals and medications to assist in refraining from smoking. Thus, the Joint Commission (JC) has recommended that hospitals screen all patients for tobacco use and offer cessation services and follow up support within 1 month of discharge. Unfortunately, few hospitals implement the JC tobacco treatment standards in part because the services require extra costs, the standards are voluntary, and the financial benefits to hospitals and insurers have yet to be documented. In the future, national health policy changes may incentivize hospitals and insurers to explore how smoking cessation services may help to control healthcare costs. For example, the Centers for Medicare and Medicaid will penalize hospitals whose 30-day readmission rates exceed allowable limits for 5 conditions: 1) acute MI, 2) heart failure, 3) pneumonia, 4) COPD and 5) hip/knee replacement). The Medical University of South Carolina recently implemented an automated in-hospital smoking cessation program using Results may not be generalized to other hospital settings. to follow-up with patients post-discharge in accordance with JC standards. This study takes advantage of in-place data capture mechanisms that allow efficient linkage between hospital clinical system, cessation program and statewide healthcare utilization datasets to examine hospital readmission and cost outcomes. The proposed study will use an interrupted time series design to examine monthly trends in readmission rates before (01/01/13-12/31/13) and after (02/01/14-01/31/15) program implementation, allowing us to test the hypothesis that an automated inpatient smoking cessation program will reduce unplanned readmissions and healthcare costs. This study provides an efficient way to examine whether investing in tobacco cessation services can help hospitals to avoid readmission penalties and reduce healthcare costs via secondary data analyses.
The Medical University of South Carolina recently implemented an automated in-hospital smoking cessation program using IVR technology to follow-up with patients post-discharge in accordance with Joint Commission Tobacco Treatment recommended standards. This study takes advantage of in-place data capture mechanisms that allow efficient linkage between hospital clinical system, cessation program and statewide healthcare utilization datasets to examine hospital readmission and cost outcomes. The proposed study will use an interrupted time series design to examine monthly trends in readmission rates before (01/01/13- 12/31/13) and after (02/01/14-01/31/15) program implementation, allowing us to test the hypothesis that an automated inpatient smoking cessation program will reduce unplanned readmissions and healthcare costs.
| Cartmell, Kathleen B; Dismuke, Clara E; Dooley, Mary et al. (2018) Effect of an Evidence-based Inpatient Tobacco Dependence Treatment Service on 1-Year Postdischarge Health Care Costs. Med Care 56:883-889 |
| Cartmell, Kathleen B; Dooley, Mary; Mueller, Martina et al. (2018) Effect of an Evidence-based Inpatient Tobacco Dependence Treatment Service on 30-, 90-, and 180-Day Hospital Readmission Rates. Med Care 56:358-363 |
