Population Health and the Academic Medical Center

Gourevitch, Marc N.

doi:10.1097/acm.0000000000000171

Cited by 53 publications

(47 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4,5 The intervention could also be incorporated into care delivery models that aim to improve population health by coordinating the care of smokers with other chronic diseases across transitions of care. 6,7,21,22 …”

Section: Discussionmentioning

confidence: 99%

Sustained Care Intervention and Postdischarge Smoking Cessation Among Hospitalized Adults

Rigotti

Regan

Levy

et al. 2014

JAMA

129

117

View full text Add to dashboard Cite

IMPORTANCE Health care systems need effective models to manage chronic diseases like tobacco dependence across transitions in care. Hospitalizations provide opportunities for smokers to quit, but research suggests that hospital-delivered interventions are effective only if treatment continues after discharge. OBJECTIVE To determine whether an intervention to sustain tobacco treatment after hospital discharge increases smoking cessation rates over standard care. DESIGN A randomized controlled trial conducted from August 2010-November 2012 compared Sustained Care, a post-discharge tobacco cessation intervention, vs. Standard Care among hospitalized adult smokers who received a tobacco dependence intervention in the hospital and wanted to quit smoking after discharge. SETTING Massachusetts General Hospital, Boston, MA. PARTICIPANTS 397 hospitalized daily smokers (mean age 53 years, 48% male, 81% nonhispanic white). 92% of eligible patients and 44% of screened patients enrolled. INTERVENTION Sustained Care participants received automated interactive voice response telephone calls and their choice of free FDA-approved cessation medication for 90 days. The automated calls promoted cessation, provided medication management, and triaged smokers for additional counseling. Standard Care patients received recommendations for post-discharge pharmacotherapy and counseling. MAIN OUTCOMES Biochemically-validated past 7-day tobacco abstinence 6 months after discharge (primary outcome); self-reported tobacco abstinence and smoking cessation treatment use at 1, 3, and 6 months. RESULTS Smokers assigned to Sustained Care (n=198) used more counseling and more pharmacotherapy at each follow-up than those assigned to Standard Care (n=199). Biochemically-validated 7-day tobacco abstinence at 6 months was higher with Sustained Care than Standard Care (26% vs. 15%; RR 1.71, 95% CI 1.14–2.56, p=0.009; NNT=9.4, 95% CI 6.4–35.5). Using multiple imputation for missing outcomes, the RR was 1.55 (95%CI 1.03–2.21, p=0.038). Sustained Care also produced higher self-reported continuous abstinence rates for 6 months after discharge (27% vs. 16%; RR 1.70, 95% CI 1.15–2.51, p=0.007). CONCLUSION Among hospitalized adult smokers who planned to quit smoking, a post-discharge intervention providing automated telephone calls and free medication resulted in higher rates of smoking cessation at 6 months compared with a standard recommendation to use counseling and medication after discharge. These findings, if replicated, suggest an approach to help achieve sustained smoking cessation after a hospital stay.

show abstract

Section: Discussionmentioning

confidence: 99%

Sustained Care Intervention and Postdischarge Smoking Cessation Among Hospitalized Adults

Rigotti

Regan

Levy

et al. 2014

JAMA

129

117

View full text Add to dashboard Cite

show abstract

“…72 Many of these connections will have been formed by private entrepreneurship and commercial activity, not government investment. Public health authority will remain important, especially with respect to social determinants of health.…”

Section: Resultsmentioning

confidence: 99%

Upstream Health Law

Sage¹,

McIlhattan²

2014

J. Law. Med. Ethics

View full text Add to dashboard Cite

For the first time, entrepreneurs are aggressively developing new technologies and business models designed to improve individual and population health, not just to deliver specialized medical care. Consumers of these goods and services are not yet "patients"; they are simply people. As this sector of the health care industry expands, it is likely to require new forms of legal governance, which we term "upstream health law."

show abstract

“…8 Train students in population-based health care, an essential concept in emerging models of accountable care. 66,79 *Special tracks are already offered or soon to be offered at several schools, including Duke, UC Davis, and Johns Hopkins †Examples include Harvard Medical School and the University of Connecticut ‡Strategies include awarding RVUs for precepting students, lump sum payment per student per rotation, teacher training, and subsidies for continuing medical education chairs, and senior faculty agree that good, ethical patient…”

Section: Resultsmentioning

confidence: 99%