Objective The study sought to determine whether interoperable, electronic health record–based referral (eReferral) produces higher rates of referral and connection to a state tobacco quitline than does fax-based referral, thus addressing low rates of smoking treatment delivery in health care. Materials and Methods Twenty-three primary care clinics from 2 healthcare systems (A and B) in Wisconsin were randomized, unblinded, over 2016-2017, to 2 smoking treatment referral methods: paper-based fax-to-quit (system A =6, system B = 6) or electronic (eReferral; system A = 5, system B = 6). Both methods referred adult patients who smoked to the Wisconsin Tobacco Quitline. A total of 14 636 smokers were seen in the 2 systems (system A: 54.5% women, mean age 48.2 years; system B: 53.8% women, mean age 50.2 years). Results Clinics with eReferral, vs fax-to-quit, referred a higher percentage of adult smokers to the quitline: system A clinic referral rate = 17.9% (95% confidence interval [CI], 17.2%-18.5%) vs 3.8% (95% CI, 3.5%-4.2%) (P < .001); system B clinic referral rate = 18.9% (95% CI, 18.3%-19.6%) vs 5.2% (95% CI, 4.9%-5.6%) (P < .001). Average rates of quitline connection were higher in eReferral than F2Q clinics: system A = 5.4% (95% CI, 5.0%-5.8%) vs 1.3% (95% CI, 1.1%-1.5%) (P < .001); system B = 5.3% (95% CI, 5.0%-5.7%) vs 2.0% (95% CI, 1.8%-2.2%) (P < .001). Discussion Electronic health record–based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates 3-4 times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals. Conclusions eReferral may help address the challenge of providing smokers with treatment for tobacco use during busy primary care visits. ClinicalTrials.gov; No. NCT02735382.

Background: Ensuring equitable access to smoking cessation services for cancer patients is necessary to avoid increasing disparities in tobacco use and cancer outcomes. In 2017, the Cancer Center Cessation Initiative (C3I) funded National Cancer Institute (NCI)-designated Cancer Centers to integrate evidence-based smoking cessation programs into cancer care. We describe the progress of C3I Cancer Centers in expanding the reach of cessation services across cancer populations. Methods: Cancer centers (n = 17) reported on program characteristics and reach (the proportion of smokers receiving evidence-based cessation treatment) for two 6-month periods. Reach was calculated overall and by patient gender, race, ethnicity, and age. Results: Average reach increased from 18.5% to 25.6% over 1 year. Reach increased for all racial/ethnic groups, and in particular for American Indian/Alaska Native (6.6-24.7%), Asian/Native Hawaiian/Pacific Islander (7.3-19.4%), and black (18.8-25.9%) smokers. Smaller gains in reach were observed among Hispanic smokers (19.0-22.8%), but these were similar to gains among non-Hispanic smokers (18.9-23.9%). By age group, smokers aged 18-24 years (6.6-14.5%) and > 65 years (16.1-24.5%) saw the greatest increases in reach. Conclusion: C3I Cancer Centers achieved gains in providing smoking cessation services to cancer patients who smoke, thereby reducing disparities that had existed across important subgroups. Taking a population-based approach to integrating tobacco treatment into cancer care has potential to increase reach equity. Implementation strategies including targeted and proactive outreach to patients and interventions to increase providers' adoption of evidence-based smoking cessation treatment may advance reach even further.

Background: Although people who smoke cigarettes are overrepresented among hospital inpatients, few are connected with smoking cessation treatment during their hospitalization. Training, accountability for medication use, and monitoring of all patients position pharmacists well to deliver cessation interventions to all hospitalized patients who smoke. Methods: A large Midwestern University hospital implemented a pharmacist-led smoking cessation intervention. A delegation protocol for hospital pharmacy inpatients who smoked cigarettes gave hospital pharmacists the authority to order nicotine replacement therapy (NRT) during hospitalization and upon discharge, and for referral to the Wisconsin Tobacco Quit Line (WTQL) at discharge. Eligible patients received the smoking cessation intervention unless they actively refused (ie, “opt-out”). The program was pilot tested in phases, with pharmacist feedback between phases, and then implemented hospital-wide. Interviews, surveys, and informal mechanisms identified ways to improve implementation and workflows. Results: Feedback from pharmacists led to changes that improved workflow, training and patient education materials, and enhanced adoption and reach. Refining implementation strategies across pilot phases increased the percentage of eligible smokers offered pharmacist-delivered cessation support from 37% to 76%, prescribed NRT from 2% to 44%, and referred to the WTQL from 3% to 32%. Conclusion: Hospitalizations provide an ideal opportunity for patients to make a tobacco quit attempt, and pharmacists can capitalize on this opportunity by integrating smoking cessation treatment into existing inpatient medication reconciliation workflows. Pharmacist-led implementation strategies developed in this study may be applicable in other inpatient settings.

Quitting smoking after a cancer diagnosis leads to better outcomes for cancer patients, including lower risk for a second primary cancer and increased survival. However, few cancer patients receive smoking cessation services during their oncology healthcare visits, and disparities in the receipt of such smoking cessation services exist. As part of the Cancer Moonshot, the National Cancer Institute (NCI) has dedicated funding to expand and enhance smoking cessation services at NCI-Designated Cancer Centers for all patients who smoke. We report on characteristics of tobacco treatment programs (TTPs) at the 22 Cancer Centers funded through the Cancer Center Cessation Initiative (C3I) for 6 months before funding was awarded (“pre-funding period”), and for 6 months during the first year of funding. We will also report on the second half of the first year of funding. Characteristics measured included referral methods to cessation services (e.g. referrals via electronic health records (EHR)), and types of cessation services offered. TTP reach (the percentage of smokers who engaged in any type of TTP) was calculated overall and by patient demographics for Centers providing aggregate patient data (n=13). Data were collected in 2018. Between the pre-funding period and first year of funding, the number of C3I funded Centers offering in-person smoking cessation counseling increased from 10 to 15 (45.5% to 68.2%). EHR referrals to tobacco treatment programs increased from 31.8% of Centers to 68.2%. Four Centers (18.2%) offered text and web based cessation programs in the first funding year compared with only 1 Center (4.5%) in the pre-funding period. During the first funding period, TTP reach on average was 20.2%, but varied by Center, ranging from 0.5% to 86.5%. During the first funding period, 16.4% of Black, 15.8% of White, 11.8% of Hispanic, 10.6% of Asian, and 6.2% of American Indian/Alaska Native smokers received smoking cessation services. About 13% of smokers aged 18-24 received cessation services, compared with those aged 25-44 (17.7%), 45-64 (22.9%) and 65+ (18.7%). The majority of C3I funded Cancer Centers offered some type of TTP; however, on average only 20% of smokers were reached by a TTP. Further, TTP reach varies by race, ethnicity, and age. The C3I provides an opportunity to improve the reach and effectiveness of smoking cessation services for cancer patients who smoke, and reduce disparities in the receipt of cessation services by providing financial and technical support for Centers to build and implement comprehensive evidence-based smoking cessation programs. Citation Format: Heather D'Angelo, Betsy Rolland, Rob Adsit, Michael Fiore, Marika Rosenblum, Glen Morgan. The NCI Cancer Center Cessation Initiative (C3I): Characteristics and reach of tobacco treatment programs among NCI-designated cancer centers in the C3I [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2433.

Quitting smoking after a cancer diagnosis leads to better outcomes for cancer patients, including lower risk for a second primary cancer and increased survival. Yet few cancer patients receive smoking cessation services during their oncology health care visits, and disparities in the receipt of such smoking cessation services exist. As part of the Cancer Moonshot, the National Cancer Institute (NCI) has dedicated funding to expand and enhance smoking cessation services at NCI-Designated Cancer Centers for all patients who smoke. We report on the baseline characteristics of tobacco treatment programs (TTPs) at the 22 Cancer Centers initially funded through the Cancer Center Cessation Initiative (C3I), for six months before funding was awarded. Characteristics measured included consistency of smoking status documentation in electronic health records (EHR), types of cessation services offered, and referral methods used. TTP reach (the percentage of smokers who engaged in any type of TTP) was calculated overall and by patient demographics for Centers providing aggregate patient data (n=11). Data were collected in 2018. Among the 22 funded Centers, 40.9% consistently documented smoking status using the EHR. At least one type of cessation service was offered at 77.3% of Centers. Quitline referral was the most frequently cited service (50%), followed by in-person TTPs (45.5%). One Center offered text and web-based programs. Only 31.8% of centers used the EHR to refer patients to TTPs; among those, one used an opt-out referral method. TTP reach on average was 22.2%, but varied by Center, ranging from 0.5% to 79.7%. About 27% of Black, 21% of White, 20.3% of Hispanic and 12.2% of Asian patients who smoked received cessation services. Less than 8% of patients aged 18-24 received cessation services compared with those aged 25-44 (18.3%), 45-64 (24.7%) and 65+ (21.9%). A slightly higher percentage of female patients (23%) received cessation services compared with males (21.7%). The majority of C3I funded Cancer Centers offered some type of TTP in the prefunding period. However, on average only 22% of smokers were reached by a TTP, and reach varied by race, age, and gender of smokers. The Cancer Center Cessation Initiative provides an opportunity for Cancer Centers to improve the reach and effectiveness of smoking cessation services for cancer patients who smoke, and reduce disparities in the receipt of cessation services by providing financial and technical support for Centers to build and implement comprehensive evidence-based smoking cessation programs. Citation Format: Heather D'Angelo, Betsy Rolland, Rob Adsit, Glen Morgan, Marika Rosenblum, Michael C. Fiore. The National Cancer Institute Cancer Center Cessation Initiative (C3I): Examining the baseline characteristics and reach of tobacco treatment programs within NCI-Designated Cancer Centers in the C3I [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A001.

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