Improving the Quality of Care for the Hospitalized Tobacco User—One Institution’s Transformational Journey

Liu, Stephen K.; Prior, Ellen; Warren, Colleen; Brown, Teresa; Snide, Jennifer; Butterly, John R.

doi:10.1007/s13187-010-0135-5

Cited by 8 publications

(6 citation statements)

References 9 publications

(8 reference statements)

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“…Table 3 presents an overview of each study 36‐98 . A summary of the characteristics of the 56 studies is presented in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…used a broad range of implementation strategies, consisting of 4 studies that all had strategies, from planning, organizing, leading, and monitoring. 72,79,90,98 These studies had a longer study period, averaging 2.5 years, and were conducted in single sites with an emphasis on internal leadership and significant follow-up periods. Studies that consisted of internally resourced development of systems and structures had a longer term follow-up period and more of a focus on longer term implementation outcomes (sustainability and penetration).…”

Section: Internally Resourced Development Of Systems and Structuresmentioning

confidence: 99%

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How can hospitals change practice to better implement smoking cessation interventions? A systematic review

Ugalde

White

Rankin

et al. 2021

CA A Cancer J Clinicians

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Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking‐cessation interventions. However, this is not well implemented in practice. In this systematic review, the authors summarize the literature on smoking‐cessation implementation strategies and evaluate their success to guide the implementation of best‐practice smoking interventions into hospital settings. The CINAHL Complete, Embase, MEDLINE Complete, and PsycInfo databases were searched using terms associated with the following topics: smoking cessation, hospitals, and implementation. In total, 14,287 original records were identified and screened, resulting in 63 eligible articles from 56 studies. Data were extracted on the study characteristics, implementation strategies, and implementation outcomes. Implementation outcomes were guided by Proctor and colleagues' framework and included acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The findings demonstrate that studies predominantly focused on the training of staff to achieve implementation. Brief implementation approaches using a small number of implementation strategies were less successful and poorly sustained compared with well resourced and multicomponent approaches. Although brief implementation approaches may be viewed as advantageous because they are less resource‐intensive, their capacity to change practice in a sustained way lacks evidence. Attempts to change clinician behavior or introduce new models of care are challenging in a short time frame, and implementation efforts should be designed for long‐term success. There is a need to embrace strategic, well planned implementation approaches to embed smoking‐cessation interventions into hospitals and to reap and sustain the benefits for people who smoke.

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“…Table 3 presents an overview of each study 36‐98 . A summary of the characteristics of the 56 studies is presented in Table 4.…”

Section: Resultsmentioning

confidence: 99%

Section: Internally Resourced Development Of Systems and Structuresmentioning

confidence: 99%

How can hospitals change practice to better implement smoking cessation interventions? A systematic review

Ugalde

White

Rankin

et al. 2021

CA A Cancer J Clinicians

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“…Improvements in smoking ascertainment were also reported in another study of a systematic approach, involving an “improvement team” of physicians, nurses, and the medical director in partnership with the New Hampshire tobacco prevention and control programme. The study aimed to increase referral and use of the state sponsored “Try To Stop Tobacco Resource Centre,” but did not report the quit rates achieved 28. The importance of continuity in providing support for smoking that transcends the interface between inpatient and community care was highlighted in a UK study by Lewis and colleagues 29.…”

Section: Discussionmentioning

confidence: 99%

Systematic identification and treatment of smokers by hospital based cessation practitioners in a secondary care setting: cluster randomised controlled trial

Murray

Leonardi‐Bee

Marsh

et al. 2013

BMJ

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Objectives To investigate the effectiveness of the systematic default provision of smoking cessation support to all adult smokers admitted to hospital, relative to usual care.Design Open, cluster randomised controlled trial.Setting Acute medical wards in one large teaching hospital in the United Kingdom.Participants 264 patients randomised to intervention and 229 to usual care; primary outcome data were available at four weeks for 260 and 224 patients, respectively. All adult smokers and recent ex-smokers able to give informed consent were eligible for entry into the study. InterventionsThe intervention comprised systematic smoking ascertainment and default provision of behavioural support and cessation pharmacotherapy for the duration of the hospital stay for all smokers and recent ex-smokers, with follow-up and referral to community services after discharge. Usual care comprised cessation support delivered at the initiative and discretion of clinical staff. All staff and patients were aware of group assignment. Main outcome measuresSmoking cessation at four weeks, validated by measuring exhaled carbon monoxide. Secondary outcomes were uptake of inpatient behavioural support, use of cessation pharmacotherapy, referral to and uptake of community support after discharge, and validated smoking cessation at six months. Participants lost to follow-up were assumed to have reverted to smoking.Results All patients in the intervention group received at least brief advice to quit smoking, compared to 106 (46%) patients in the usual care group. Cessation at four weeks was achieved by 38% (n=98) of intervention patients and 17% (n=37) of usual care patients (adjusted odds ratio 2.10 (95% confidence interval 0.96 to 4.61), P=0.06, number of patients needed to treat 8). Uptake of inpatient behavioural support, use of pharmacotherapy, and referral to and uptake of community support after discharge were all substantially and statistically significantly higher in the intervention group than in the usual care group. Cessation at six months was achieved by 19% (n=47) of intervention and 9% (n=19) of usual care patients, although this difference was not significant (adjusted odds ratio 1.53 (95% confidence interval 0.60 to 3.91); P=0.37).Conclusions Substantial improvements in smoking cessation among smokers admitted to hospital can be achieved by systematic ascertainment and delivery of cessation support in secondary care. Trial registration International Standard Randomised Controlled Trial Number ISRCTN25441641. IntroductionTobacco smoking is the largest avoidable cause of premature death and disability in both developed and developing countries. Half of all lifelong smokers die as a consequence of their smoking, typically from lung cancer, chronic obstructive pulmonary disease, or cardiovascular disease.1 Average life expectancy among smokers is 10 years less than among never smokers, and quitting smoking generates considerable benefits in both quantity and quality of life, almost irrespective of age at quitting.1 Inte...

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“…12 These voluntary tobacco measures are one of the six core measures that can be used for hospital accreditation. 12 While there are some published studies that describe models for integrating such measures into hospital systems, 13 – 16 to the best of our knowledge, this is the first study that describes the impact of such programs on provider knowledge and practice related to inpatient tobacco use treatment.…”

Section: Introductionmentioning

confidence: 99%

Provider satisfaction with an inpatient tobacco treatment program: results from an inpatient provider survey

Trout¹,

Ripley‐Moffitt²,

Meernik³

et al. 2017

IJGM

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BackgroundHospitalization offers an optimal environment for ensuring that patients receive evidence-based treatment. An inpatient tobacco treatment program can deliver interventions broadly, but minimal research has examined the impacts of a consult program on inpatient providers. The Nicotine Dependence Program at the University of North Carolina has provided an inpatient tobacco treatment consult service since 2010.ObjectiveThe program sought feedback from inpatient providers to examine factors that prompted tobacco treatment consult orders, the impact on provider counseling behavior, provider satisfaction, and suggested program improvements.DesignProviders who had ordered a tobacco treatment consult received an online anonymous survey.SettingThe University of North Carolina Hospital is an academic medical facility with 803 beds and over 37,000 inpatient admissions annually from all 100 counties in North Carolina. Approximately 20% of these inpatients report current use of any tobacco product.Patients/participantsMedical providers who ordered inpatient tobacco treatment consults from July 2012 to June 2013 (n=265) received the survey, with 118 providers responding (44.5% response rate).ResultsAlmost all providers reported being satisfied with the consult program and believed it was effective. Key factors in provider satisfaction included ease of accessing the service, saving provider time, and offering patients evidence-based tobacco use treatment. The consult program increased the likelihood of providers prescribing tobacco cessation medications at discharge, as well as following up at post-discharge appointments.ConclusionThis is some of the first research to show provider satisfaction, program usage, and outcomes with an inpatient tobacco treatment program and demonstrates the important impact of implementing tobacco treatment services within hospitals.

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Improving the Quality of Care for the Hospitalized Tobacco User—One Institution’s Transformational Journey

Cited by 8 publications

References 9 publications

How can hospitals change practice to better implement smoking cessation interventions? A systematic review

How can hospitals change practice to better implement smoking cessation interventions? A systematic review

Systematic identification and treatment of smokers by hospital based cessation practitioners in a secondary care setting: cluster randomised controlled trial

Provider satisfaction with an inpatient tobacco treatment program: results from an inpatient provider survey

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