||2P01CA180945-06 Interpret this number
||University Of Wisconsin-Madison
||Optimized Chronic Care for Smokers: Developing and Implementing Integrated Clinical and Systems Interventions in Primary Care
Tobacco smoking is the leading preventable cause of cancer death. However, healthcare systems have not
realized their potential to reduce smoking prevalence; far too few patients who smoke are offered and use
smoking treatments and such treatments are insufficiently effective. This Program Project addresses these key
obstacles by developing an especially effective comprehensive chronic care smoking treatment to reduce
smoking prevalence in healthcare via 4 individual projects and 3 cores. This Program Project will balance
internal and external validity via powerful, innovative research methods such as the Multiphase Optimization
Strategy (MOST) while also using real-world primary care clinics, patients, and staff, and using the RE-AIM
framework to enhance its public health impact. Using a factorial design, the Cessation Screening Project will
evaluate four experimental factors in 608 smokers willing to quit to determine, for the first time, which
intervention strategies (Preparation Medication, Extended Medication, and Counseling Modality) combine to
produce especially effective Optimized Varenicline and Combination Nicotine Replacement Therapy (C-NRT)
Treatment Packages based on cost and 1-year abstinence. The Health System Reach Interventions Project
will, for the first time, use a factorial experiment to evaluate three interventions intended to increase the use of
cessation treatments (i.e., reach) over 2 years in 1664 smokers initially unwilling to quit: 1) Monetary Incentives
to Use Smoking Treatment, 2) Electronic Health Record (EHR) Based Automated Tailored Outreach, and 3)
Care Management. An Optimized Reach Intervention Package will be developed that produces especially high
rates of varenicline and C-NRT cessation treatment use by smokers initially unwilling to quit. The Optimized
Care Project will comprise two randomized controlled trials (RCTs) that evaluate the Optimized Cessation
and Reach Intervention Packages developed in the Cessation and Reach Projects. One RCT will compare
Optimized Cessation Treatment versus Standard Care (physician & quitline referral) on 1-year abstinence in
600 smokers willing to quit. The second RCT will compare combined Optimized Reach and Cessation
Interventions versus Standard Care on cessation treatment use and 1-year abstinence in 900 smokers initially
unwilling to quit. The Implementation Project will assess the reach, implementation (fidelity, adaptation,
relation with effectiveness), patient representativeness, and maintenance of interventions in the other 3
projects using EHR, survey, qualitative, and observational data at patient, staff, clinic, and system levels. This
Program Project will be supported by Administration & Logistics, Data Analysis, and Optimization Cores and by
shared resources: collaborating healthcare systems and recruitment via an enhanced EHR. This Program
Project will develop a chronic care smoking treatment for healthcare that includes optimized reach and
cessation interventions that can be readily implemented and disseminated and that markedly increase the use
and effectiveness of cessation treatment, ultimately reducing smoking prevalence and cancer deaths.
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