CONNECT: COmpreheNsive traiNing and Engagement in Cessation Treatment

PROJECT SUMMARY
Adult smoking prevalence in the United States (US) is approximately 14% nationwide, yet significant disparities
persist, including among adults with annual household incomes <$35,000 (21.3%), Medicaid recipients
(23.9%), and the uninsured (23.9%). These populations are also less likely to receive smoking cessation
assistance and to use evidence-based cessation interventions. Many public health agendas emphasize
addressing these inequalities to reduce smoking related morbidity and mortality. To do this, we need to
increase accessibility to cessation services among these populations. Community health centers (CHCs) are
ideal settings to reach smokers who are socioeconomically disadvantaged as they provide care to 29 million
patients, the majority of whom are uninsured or publicly insured. Integrating Quitline referrals into these
settings has the potential to reach a large number of smokers. Bidirectional eReferral systems, which allow
providers to send a referral directly to the Quitline from the electronic health record (EHR) and Quitlines to
send information about the patient's disposition back into the patient's individual EHR, provide a platform for
more efficient and standardized referral systems. This method has increasedQuitline reach compared to faxed
orindirect referral methods; however,the Centers for Disease Control and Prevention's goal for Quitlines to
reach 8% of all tobacco users annually has not been met. A critical knowledge gap exists in how best to
implement Quitline eReferral systems into health care settings to maximize the reach and effectiveness of
cessation services. Enhanced academic detailing, which includes educational outreach and performance audit
and feedback, can increase the use of best practices and the uptake of new processes and procedures among
health care providers; however, in-person and ongoing enhanced academic detailing is infrequently used for
Quitline referral implementation. Almost half of all US states report no staff training related to their provider
referral programs. This cluster-randomized trial will recruit 30 Oregon CHCs (n~15,000 patients who smoke).
Half of the clinics will be randomized to receive the Quitline eReferral system with enhanced academic
detailing (intervention condition; n=15 clinics) and half to receive the Quitline eReferral system without
enhanced academic detailing (comparison condition; n=15 clinics). This pragmatic trial will use EHR and
Quitline data to assess rates of smoking cessation assistance reach and effectiveness among patients in the
intervention clinics compared with rates among patients in the comparison clinics. We will also evaluate the
cost-effectiveness of the eReferral system, both with and without enhanced academic detailing. This scalable
intervention has high potential to increase accessibility to smoking cessation treatment through the
collaboration between state Quitlines and CHCs that serve large numbers of socioeconomically disadvantaged
smokers. This study addresses the National Cancer Institute's research priority of developing targeted and
scalable interventions to reduce smoking among this vulnerable population.

Grant Number: 5R01CA255016-05
NIH Institute/Center: NIH
Principal Investigator: Steffani Bailey