The Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Dr, 27599, Chapel Hill, NC, United States.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Prev (2022). 2022 Jun;43(3):375-386. doi: 10.1007/s10935-022-00672-5. Epub 2022 Mar 17.
We examined whether an evidence-based cardiovascular disease risk reduction intervention (Heart Health Now) would improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. Heart Health Now was a stepped wedge, stratified, cluster randomized trial for primary care practices that were staffed by 10 or fewer clinicians and had an electronic health record. The Heart Health Now intervention consisted of education tools, onsite practice facilitation for one year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. Our primary outcomes were practice-level rates of tobacco screening and tobacco cessation support-extracted from practices' electronic health records-and measured at pre-intervention and 6 months post-intervention. The 28 practices included in our analyses represented 78,120 patients and 17,687 smokers. Significant change occurred in practices' tobacco screening rates and cessation support rates over time. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2% (p < 0.001). Similarly, cessation support rates significantly increased from 44.3 to 50.1% (p = 0.03). Several practice-level factors were associated with improvement including being in an academic health center or faculty practice, having more clinicians, and having a lower percentage of White patients. In conclusion, a multi-component intervention focused on multiple cardiovascular disease risk reduction in multiple small primary care practices successfully improved rates of tobacco screening and cessation support.
我们研究了基于证据的心血管疾病风险降低干预措施（现在心脏健康）是否会提高北卡罗来纳州小型初级保健实践中烟草戒断筛查和咨询的比例。Heart Health Now 是一项针对初级保健实践的阶梯式、分层、集群随机试验，这些实践由 10 名或更少临床医生组成，并拥有电子健康记录。Heart Health Now 干预措施包括教育工具、为期一年的现场实践促进以及特定实践的心血管人群管理仪表板，其中包括每月、特定措施的运行图表，以帮助指导质量改进。我们的主要结果是从实践的电子健康记录中提取的实践层面的烟草筛查和烟草戒断支持率，并在干预前和干预后 6 个月进行测量。我们分析中包含的 28 个实践代表了 78120 名患者和 17687 名吸烟者。随着时间的推移，实践的烟草筛查率和戒烟支持率发生了显著变化。从干预前到干预后，筛查率从 82.7%显著增加到 96.2%（p<0.001）。同样，戒烟支持率从 44.3%显著增加到 50.1%（p=0.03）。几个实践层面的因素与改善相关，包括在学术医疗中心或教师实践中、有更多的临床医生和有较低比例的白人患者。总之，一项针对多个小型初级保健实践中多种心血管疾病风险降低的多组分干预措施成功提高了烟草筛查和戒烟支持的比例。
