A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

David Katz; Mark Vander Weg; Steve Fu; Allan Prochazka; Kathleen Grant; Lynne Buchanan; David Tinkelman; Heather Schacht Reisinger; John Brooks; Stephen L Hillis; Anne Joseph; Marita Titler

doi:10.1186/1748-5908-4-58

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A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

Journal article

Open access

Peer reviewed

A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

David Katz, Mark Vander Weg, Steve Fu, Allan Prochazka, Kathleen Grant, Lynne Buchanan, David Tinkelman, Heather Schacht Reisinger, John Brooks, Stephen L Hillis, …

Implementation science : IS, Vol.4(1), pp.58-58

2009

DOI: 10.1186/1748-5908-4-58

PMCID: PMC2753631

PMID: 19744339

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Abstract

Background: Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. Specific objectives: The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Design: Pre-post study design in four VA hospitals. Participants: Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. Intervention: The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. Outcomes: The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the clustered nature of the data within nurses and hospitals into account. We will assess attitudes of staff nurses toward cessation counseling by questionnaire and will identify barriers and facilitators to implementation by using clinician focus groups. To determine the short-term incremental cost per quitter from the perspective of the VA health care system, we will calculate cessation-related costs incurred during the initial hospitalization and six-month follow-up period.

Study Protocol

Details

Title: Subtitle: A before-after implementation trial of smoking cessation guidelines in hospitalized veterans
Creators: David Katz - Department of Medicine, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, IA, USA
Mark Vander Weg - Department of Medicine, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, IA, USA
Steve Fu - Center for Chronic Disease and Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, USA
Allan Prochazka - Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO, USA
Kathleen Grant - Department of Psychiatry, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
Lynne Buchanan - The College of Nursing, University of Nebraska, Omaha, NE, USA
David Tinkelman - Health Initiatives Program, National Jewish Health, Denver, CO, USA
Heather Schacht Reisinger - Department of Medicine, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, IA, USA
John Brooks - College of Pharmacy, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, IA, USA
Stephen L Hillis - Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, University of Iowa, Iowa City, IA, USA
Anne Joseph - Department of Medicine, University of Minnesota, Minneapolis, MN, USA
Marita Titler - Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, University of Iowa, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Implementation science : IS, Vol.4(1), pp.58-58
DOI: 10.1186/1748-5908-4-58
PMID: 19744339
PMCID: PMC2753631
NLM abbreviation: Implement Sci
ISSN: 1748-5908
eISSN: 1748-5908
Publisher: BioMed Central
Language: English
Date published: 2009
Academic Unit: Radiology; Pharmacy; Epidemiology; Psychological and Brain Sciences; Biostatistics; Center for Social Science Innovation; Injury Prevention Research Center; General Internal Medicine; Community and Behavioral Health; Internal Medicine
Record Identifier: 9984063126902771

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