Cessation Service Use and Effectiveness for Hospitalized Smokers

The goal of this patient-randomized effectiveness trial is to demonstrate that an inpatient
technology-supported assisted referral (I-TSAR) and follow-up approach is an effective and
cost-effective method to help hospitalized patients successfully quit smoking. The proposed
study represents a unique opportunity to assess the effectiveness and cost-effectiveness of
linking inpatient and outpatient delivery of smoking cessation services in two large and
very different health care delivery systems. We will enroll 900 participants (600
intervention, 300 controls) over 15-months and collect follow-up survey and health care
utilization data over 12 months to estimate: 1) smoking abstinence at 6 and 12 months for
I-TSAR intervention recipients compared to usual care; 2) the dose effect on smoking
abstinence at 6 and 12 months for I-TSAR recipients compared to usual care; 3) total and
mean costs per participant for I-TSAR and usual care recipients, and, if effective, estimate
the incremental cost-effectiveness of the intervention vs. controls at 12 months from health
plan/insurer and societal perspectives; and 4) differences in health care utilization at 12
months for I-TSAR versus controls.

This innovative study will provide important evidence for the effectiveness and cost
effectiveness of technologically supporting hospital-based tobacco treatment specialists'
efforts to provide treatment assistance to smokers interested in quitting and arrange for
telephone follow-up support. The Tobacco Treatment Specialists will identify and enroll into
the study smokers and recent quitters (ages 18 and over) admitted to KSMC and OHSU inpatient
units, and randomize participants into usual care and I-TSAR intervention arms. Patients
enrolled into the treatment arm will receive information about existing tobacco cessation
programs and medications, will be enrolled into the cessation program and medication of
their choice while admitted, and will be enrolled to receive four post-discharge follow-up
calls over 7 weeks using an automated interactive voice recognition program developed with
and provided by Eliza Corp. The Tobacco Treatment Specialist will work with hospital staff
to initiate pharmacy orders for cessation medications, and coordinate cessation treatment
with the participants' usual source of primary care (provider or clinic). Study staff will
also work with hospital staff and managers to develop periodic clinic enrollment feedback
reports.

Testing the approach in two different health care systems will provide generalized data for
other health plans and insurers about the value of using electronic medical records systems
to help inpatient staff facilitate smoking cessation treatment after discharge.

Inclusion Criteria:

- willing to remain abstinent post discharge

- 1 cpd past 30 days

- active phone

- has a usual source of care

- willing to participate

- willing to provide contact information for follow up

- provide informed consent

Exclusion Criteria:

- critical care or labor/delivery units

- pregnant or breastfeeding

- physically unable to participate

- cognitively impaired

- no phone