Reeves Gordon R, Wang Tracy Y, Reid Kimberly J, Alexander Karen P, Decker Carole, Ahmad Homaa, Spertus John A, Peterson Eric D
Department of Internal Medicine, Duke Clinical Research Institute, Durham, NC 27705, USA.
Arch Intern Med. 2008 Oct 27;168(19):2111-7. doi: 10.1001/archinte.168.19.2111.
Recognizing the importance of smoking cessation after acute myocardial infarction (AMI), the Centers for Medicare & Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations currently uses documentation of smoking cessation counseling (SCC) as a metric of hospitals' quality of AMI care. Yet, the association between hospitals' performance of this quality measure and subsequent tobacco cessation rates has not been established.
We analyzed 889 consecutive smokers treated for AMI at 19 hospitals in PREMIER (Prospective Registry Evaluating Myocardial Infarction: Events and Recovery) between January 1, 2003, and June 28, 2004. Patients were followed up for 1 year after hospitalization. Multivariate regression modeling was performed to determine the association between hospital-level documented SCC rates and tobacco cessation rates after discharge.
On a hospital level, the median medical record-documented SCC rate was 72.0% (interquartile range, 59.6%-90.1%). At 1 year, the median smoking cessation rate was 55.6% (interquartile range, 37.5%-61.9%). Although patients with documented SCC were more likely to recall receiving SCC at 1 month (86.1% vs 70.8%, P < .001), their rate of quitting at 1 year was lower than that of patients without documented SCC (50.1% vs 60.7%, P = .02; relative risk, 0.76; 95% confidence interval, 0.61-0.94). At the hospital level, there was no correlation between SCC documentation and successful quitting at 6 months (r = -0.19, P = .11) or 1 year (r = -0.13, P = .45).
The performance metric for SCC, as it is currently structured, does not correlate with actual smoking cessation at 6 months or 1 year. Revision of this performance measure should be considered to more effectively reflect the goal of promoting smoking cessation.
认识到急性心肌梗死（AMI）后戒烟的重要性，医疗保险和医疗补助服务中心以及医疗保健机构认证联合委员会目前将戒烟咨询（SCC）的记录作为医院AMI护理质量的一项指标。然而，医院在这项质量指标上的表现与随后的戒烟率之间的关联尚未确立。
我们分析了2003年1月1日至2004年6月28日期间在PREMIER（评估心肌梗死：事件与恢复的前瞻性登记研究）的19家医院接受AMI治疗的889名连续吸烟者。患者在住院后随访1年。进行多变量回归建模以确定医院层面记录的SCC率与出院后戒烟率之间的关联。
在医院层面，病历记录的SCC率中位数为72.0%（四分位间距，59.6% - 90.1%）。1年时，戒烟率中位数为55.6%（四分位间距，37.5% - 61.9%）。尽管有SCC记录的患者在1个月时更有可能回忆起接受过SCC（86.1%对70.8%，P <.001），但他们1年时的戒烟率低于没有SCC记录的患者（50.1%对60.7%，P =.02；相对风险，0.76；95%置信区间，0.61 - 0.94）。在医院层面，SCC记录与6个月（r = -0.19，P =.11）或1年（r = -0.13，P =.45）时的成功戒烟之间没有相关性。
目前构建的SCC绩效指标与6个月或1年时的实际戒烟情况不相关。应考虑修订该绩效指标，以更有效地反映促进戒烟的目标。
