Rapid Cycle Evaluation and Adaptation of an Inpatient Tobacco Treatment Service at a U.S. Safety-Net Hospital

Background To address disparities in smoking rates, our safety-net hospital implemented an inpatient tobacco treatment intervention: an “opt-out” electronic health record (EHR)-based Best Practice Alert + order-set, which triggers consultation to a Tobacco Treatment Consult (TTC) service for all hos...

Ausführliche Beschreibung

Gespeichert in:

Bibliographische Detailangaben
Veröffentlicht in:	Implementation research and practice Jg. 2; S. 26334895211041295
Hauptverfasser:	Kathuria, Hasmeena, Herbst, Nicole, Seth, Bhavna, Clark, Kristopher, Helm, Eric D., Zhang, Michelle, O’Donnell, Charles, Fitzgerald, Carmel, Itchapurapu, Indira Swetha, Waite, Meg, Wong, Carolina, Swamy, Lakshmana, Olson, Jen, Mishuris, Rebecca G., Wiener, Renda Soylemez
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	London, England SAGE Publications 01.01.2021 SAGE Publishing
Schlagworte:	Original Empirical Research electronic health record (EHR) consolidated Framework for Implementation Research (CFIR) smoking cessation inpatient tobacco treatment rapid-cycle evaluations expert Recommendations for Implementing Change (ERIC)
ISSN:	2633-4895, 2633-4895
Online-Zugang:	Volltext
Tags:	Tag hinzufügen Keine Tags, Fügen Sie den ersten Tag hinzu!

Beschreibung
Zusammenfassung:	Background To address disparities in smoking rates, our safety-net hospital implemented an inpatient tobacco treatment intervention: an “opt-out” electronic health record (EHR)-based Best Practice Alert + order-set, which triggers consultation to a Tobacco Treatment Consult (TTC) service for all hospitalized patients who smoke cigarettes. We report on development, implementation, and adaptation of the intervention, informed by a pre-implementation needs assessment and two rapid-cycle evaluations guided by the Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC) compilation. Methods We identified stakeholders affected by implementation and conducted a local needs assessment starting 6 months-pre-launch. We then conducted two rapid-cycle evaluations during the first 6 months post-implementation. The CFIR informed survey and interview guide development, data collection, assessment of barriers and facilitators, and selection of ERIC strategies to implement and adapt the intervention. Results Key themes were: (1) Understanding the hospital's priority to improving tobacco performance metrics was critical in gaining leadership buy-in (CFIR Domain: Outer setting; Construct: External Policy and Incentives). (2) CFIR-based rapid-cycle evaluations allowed us to recognize implementation challenges early and select ERIC strategies clustering into 3 broad categories (conducting needs assessment; developing stakeholder relationships; training and educating stakeholders) to make real-time adaptations, creating an acceptable clinical workflow. (3) Minimizing clinician burden allowed the successful implementation of the TTC service. (4) Demonstrating improved 6-month quit rates and tobacco performance metrics were key to sustaining the program. Conclusions Rapid-cycle evaluations to gather pre-implementation and early-implementation data, focusing on modifiable barriers and facilitators, allowed us to develop and refine the intervention to improve acceptability, adoption, and sustainability, enabling us to improve tobacco performance metrics in a short timeline. Future directions include spreading rapid-cycle evaluations to promote implementation of inpatient tobacco treatment programs to other settings and assessing long-term sustainability and return on investment of these programs.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2633-4895 2633-4895
DOI:	10.1177/26334895211041295