Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial

Abstract

BackgroundThe objectives of this smoking cessation study among hospitalized smokers are to: 1) determine provider and patient receptivity, barriers, and facilitators to implementing the nurse-administered, inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys; 2) compare the effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus usual care across hospitals, units, and patient characteristics using thirty-day point prevalence abstinence at thirty days and six months (primary outcome) post-recruitment; and 3) determine the cost-effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention relative to usual care including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved.Methods/DesignThis effectiveness study will be a quasi-experimental design of six Michigan community hospitals of which three will get the nurse-administered Tobacco Tactics intervention and three will provide their usual care. In both the intervention and usual care sites, research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at thirty days and six months post-recruitment. The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site. The Master Trainers, in turn, will teach the intervention to all staff nurses. Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination.Descriptive statistics will be used to summarize the results of surveys administered to nurses, nurses’ participation rates, smokers’ receipt of specific cessation services, and satisfaction with services. General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates, respectively, with adjustment for the clustering of patients within hospital units. Regression analyses will test the moderation of the effects of the interventions by patient characteristics. Cost-effectiveness will be assessed by constructing three ratios including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved.DiscussionGiven that nurses represent the largest group of front-line providers, this intervention, if proven effective, has the potential for having a wide reach and thus decrease smoking, morbidity and mortality among inpatient smokers.Trial registrationDissemination of Tobacco Tactics for Hospitalized Smokers NCT01309217

Smoking-Cessation Interventions for Urban Hospital Patients

“…First and foremost, enrollment into post-discharge cessation treatment should probably be conducted by staff nurses as part of their routine admission tasks, as done by Duffy and colleagues 38 in their study within the CHART consortium, thereby eliminating the category of smokers ( n =3,047) discharged before they could be reached. Second, because more than 4,000 smokers were ineligible because of not having a U.S. phone number, studies should examine whether giving these smokers a cell phone (or connecting them to existing phone distribution programs) is feasible and effective.…”

“…A hospital adopting the multisession counseling arm would likely have more variability in counseling from one patient to the next, although the Public Health Service guidelines 40 would suggest the effectiveness would still be quite similar. Furthermore, only 9% of all smokers were enrolled in the study, and having hospital staff involved in the intervention could increase its reach, as suggested above, similar to the methods used by Duffy et al 38 …”

Effectiveness of the Tobacco Tactics Program in the Trinity Health System

“…12 In brief, this study, conducted from 2010 to 2013 and analyzed from 2014 to 2015, was a pragmatic, quasi-experimental trial initially conducted and analyzed in six Michigan Trinity Health community hospitals (matched on size and number of minority patients), of which three were to receive the nurse-administered Tobacco Tactics intervention and three were to receive usual care, although data from one of the control hospitals was not useable owing to a protocol deviation. In order to eliminate investigator bias, a random number generator was used to assign the hospitals to experimental or control conditions.…”

CHARTing a Path to Pragmatic Tobacco Treatment Research

“…Five of the projects were two-arm RCTs comparing active interventions to usual care 6-10 ; one used a factorial design to test the effects of two different interventions alone and in combination 11 ; and the last used group randomization procedures to assign hospitals to intervention and control conditions. 12 Some interventions were initiated during hospitalization, 6,12 but most were delivered post-discharge. 10,11 Table 1 provides study details.…”