Health Studies Research Division, Department of Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA, USA.
Acad Emerg Med. 2009 Nov;16(11):1186-92. doi: 10.1111/j.1553-2712.2009.00551.x.
Due to the addictive nature of the disease and interrelated societal influences on the behavior of tobacco use, repeated interventions are often required before people successfully stop using tobacco. Our objective was to implement a multicomponent clinical intervention initiative enabling health care providers to effectively screen for tobacco use. We also sought to describe changes in emergency medicine providers' documentation of cessation advice to tobacco users.
The intervention was conducted at three emergency departments (EDs) and four clinics at a community-based teaching hospital and health network. Health care providers with the opportunity to identify and counsel tobacco-using patients in ambulatory health care settings were the study population. The authors initiated a quality improvement initiative for tobacco screening that employed a multicomponent strategy to facilitate systemic changes that support 100% tobacco use identification, documentation, and counseling. Baseline, posteducation, and post-wrap-around documented screening rates were compared within each site across the intervention. Cumulative ED baseline, posteducation, and post-wrap-around rates of provider advice to tobacco users were compared across the intervention. Percentage of possible available gain was calculated in consideration of a 100% ceiling effect. Statistical analysis was performed using SPSS and MetStat. Descriptive statistics and Pearson's chi-square cell frequency were used to analyze and compare sites. Fisher's exact test was used to compare those tests with a chi-square cell frequency of five or less. The statistical tests used for pre-/postintervention percentage comparisons by site had power between 80% and 90%, detecting differences of 10% and 20% or more at a 0.05 level of significance.
Significant increases in posteducation screening rates for all ED sites complemented significant increases in ED post-wrap-around intervention screening rates. Significant increases in ED provider documented cessation advice were also noted.
This initiative successfully changed tobacco screening behavior of health care providers at all sites. It was particularly successful in the ED, typically an environment less likely to be conducive to preventive health interventions.
由于疾病的成瘾性和社会因素对烟草使用行为的相互影响，人们通常需要多次干预才能成功戒烟。我们的目标是实施一项多组分临床干预措施，使医疗保健提供者能够有效地对烟草使用进行筛查。我们还试图描述急诊医学提供者对烟草使用者戒烟建议的记录变化。
该干预措施在一家社区教学医院和医疗网络的三个急诊部（ED）和四个诊所进行。有机会在门诊保健环境中识别和劝导烟草使用者的医疗保健提供者是研究对象。作者发起了一项烟草筛查质量改进倡议，采用多组分策略促进系统变革，以支持 100%的烟草使用识别、记录和咨询。在整个干预过程中，比较了每个地点的基线、教育后和 wrap-around 后的筛查率。比较了整个干预过程中 ED 基线、教育后和 wrap-around 后提供者对烟草使用者建议的累积率。考虑到 100%的上限效应，计算了可能获得的百分比。使用 SPSS 和 MetStat 进行统计分析。使用描述性统计和 Pearson 卡方单元格频率分析和比较站点。对于卡方单元格频率为五或更少的测试，使用 Fisher 精确检验。使用每个站点的预/后干预百分比比较的统计检验具有 80%至 90%的功效，可在 0.05 水平上检测到 10%和 20%或更多的差异。
所有 ED 站点的教育后筛查率显著增加，同时 ED wrap-around 干预后的筛查率也显著增加。ED 提供者记录的戒烟建议也显著增加。
该倡议成功改变了所有站点医疗保健提供者的烟草筛查行为。它在 ED 中特别成功，ED 通常不太利于进行预防性健康干预。
