R01HL156851

Implementing Effective Smoking Cessation Pharmacotherapy for Hospitalized Smokers with Cardiopulmonary Disease - Project Summary

Tobacco use remains the leading cause of death in the United States and contributes to more than 7 million hospitalizations annually. Hospitalization offers a critical window for intervention: hospital policies prohibit smoking, patients are highly motivated to quit, and societal guidelines recommend that clinicians should counsel patients and prescribe smoking cessation pharmacotherapy (SCP) to virtually all smokers. Nevertheless, only 22% of patients are ever prescribed SCP while hospitalized, and only 1% of patients are prescribed guideline-concordant SCP. This failure ultimately contributes to a 70-80% smoking relapse rate, most of which occurs within a few days of hospital discharge – well before outpatient follow-up can occur.

If we are to capitalize on the opportunity that hospitalization provides to maximize smoking cessation treatment and outcomes, new strategies are needed to overcome the low uptake of guideline-concordant SCP by physicians and patients. To address this problem, we propose to deploy a nurse practitioner-led, hospital-based tobacco treatment team to:

1) Prescribe individually tailored and guideline-concordant SCP;
2) Counsel and motivate patients to use SCP properly; and
3) Manage a mobile phone-based text-messaging system to keep patients motivated and adherent to SCP.

Our preliminary data suggest that such an approach is feasible and acceptable to patients, physicians, and hospital administrators.

In Aim 1, we will perform a parallel-group implementation-effectiveness randomized trial among 424 hospitalized smokers with cardiopulmonary disease in a large tertiary hospital. We will compare rates of SCP use and smoking cessation between patients who received the intervention and those who did not.

In Aim 2, we will measure the economic value of the intervention from both a hospital and payer perspective to better inform hospital and insurance policies and sustainability.

In Aim 3, we will perform qualitative interviews with patients, physicians, staff members, and hospital administrators to evaluate the acceptability and sustainability of our strategies.

We hypothesize that our intervention will: improve guideline-concordant SCP use; increase 6-month smoking cessation rates; be acceptable to patients, clinicians, and administrators; and be cost-effective and sustainable.

Our multi-disciplinary team has broad experience in cardiopulmonary medicine, tobacco treatment, implementation science, medication adherence, qualitative methods, health economics, and text message technology.

At the conclusion of this grant, our team will develop a detailed, evidence-informed implementation guide for a hospital-based tobacco treatment team. Ultimately, we anticipate the knowledge gained from this study will facilitate widespread and effective hospital-based tobacco treatment so that more patients lead lives free from tobacco and cardiopulmonary disease.

Baystate Medical Center

THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI) PROVIDES GLOBAL LEADERSHIP FOR A RESEARCH, TRAINING, AND EDUCATION PROGRAM TO PROMOTE THE PREVENTION AND TREATMENT OF HEART, LUNG, AND BLOOD DISEASES AND ENHANCE THE HEALTH OF ALL INDIVIDUALS SO THAT THEY CAN LIVE LONGER AND MORE FULFILLING LIVES. TO FOSTER HEART AND VASCULAR RESEARCH IN THE BASIC, TRANSLATIONAL, CLINICAL AND POPULATION SCIENCES, AND TO FOSTER TRAINING TO BUILD TALENTED YOUNG INVESTIGATORS IN THESE AREAS, FUNDED THROUGH COMPETITIVE RESEARCH TRAINING GRANTS. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO STIMULATE TECHNOLOGICAL INNOVATION; USE SMALL BUSINESS TO MEET FEDERAL RESEARCH AND DEVELOPMENT NEEDS; FOSTER AND ENCOURAGE PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY SOCIALLY AND ECONOMICALLY DISADVANTAGED PERSONS; AND INCREASE PRIVATE-SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE TECHNOLOGICAL INNOVATION; FOSTER TECHNOLOGY TRANSFER THROUGH COOPERATIVE R&D BETWEEN SMALL BUSINESSES AND RESEARCH INSTITUTIONS, AND INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL R&D.

93.837 - Cardiovascular Diseases Research

National Heart Lung and Blood Institute (NHLBI) [HHS - NIH]

Springfield, Massachusetts 011991001 United States

Single Zip Code

Dissemination and Implementation Research in Health (R01 Clinical Trial Optional) (PAR-19-274)

Amendment Since initial award the total obligations have increased 355% from $736,010 to $3,347,011.