Dr. Chen, Dr. Brownson, and Dr. Bierut are with the Siteman Cancer Center and Institute of Public Health Sciences, and Dr. Chen and Dr. Bierut are also with the Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis. Dr. Brownson is also with the School of Social Work, Washington University in St. Louis. Dr. Baker is with the Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Dr. Korpecki, Dr. Johnson, and Dr. Hook are with BJC Behavioral Health, BJC Healthcare, St. Louis. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column.
Psychiatr Serv. 2018 Aug 1;69(8):849-851. doi: 10.1176/appi.ps.201700399. Epub 2018 Jun 1.
Patients with serious mental illness have high smoking prevalence and early mortality. Inadequate implementation of evidence-based smoking cessation treatment in community mental health centers (CMHCs) contributes to this disparity. This column describes a study of the effects of quality improvement strategies on treatment and cessation outcomes among patients with serious mental illness at four CMHCs. Two low-burden strategies, decision support and academic detailing with data-driven feedback, were implemented in the CMHCs' clinics from 2014 to 2016. Pre- and postimplementation data from pharmacy and medical records were analyzed. The percentage of patients receiving cessation medication increased from 5% to 18% (p≤.001), and smoking prevalence decreased from 57% to 54% (p≤.001). This quality improvement approach holds great potential for increasing the level of smoking cessation care for patients treated in CMHC settings. Decision support and academic detailing with feedback may be effective strategies to promote best practices.
患有严重精神疾病的患者吸烟率高，早亡率也高。社区心理健康中心（CMHC）对基于证据的戒烟治疗的执行不足，导致了这种差异。本专栏介绍了一项针对四家 CMHC 严重精神疾病患者的治疗和戒烟效果的质量改进策略研究。从 2014 年到 2016 年，在 CMHC 的诊所中实施了两种低负担策略，即决策支持和基于数据的反馈的学术细化。对药房和医疗记录的实施前后数据进行了分析。接受戒烟药物治疗的患者比例从 5%增加到 18%（p≤.001），吸烟率从 57%下降到 54%（p≤.001）。这种质量改进方法对于提高 CMHC 治疗患者的戒烟护理水平具有巨大潜力。决策支持和基于数据的反馈的学术细化可能是促进最佳实践的有效策略。
