Background:
Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of "forced abstinence" for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231).
Methods:
The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW) and at Oregon Health & Science University (OHSU) hospitals in Portland, Oregon. The study will assess the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR+IVR) follow-up calls, compared to usual care inpatient counseling (UC). Starting in November 2011 we will recruit 900 hospital patients age >18 years who smoked >1 cigarettes in the past 30 days, are willing to remain abstinent post-discharge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR+IVR or UC using a 2:1 assignment strategy. Participants in the AR+IVR arm will receive a brief inpatient-cessation consult plus a referral to available outpatient cessation programs and medications, and 4 IVR follow-up calls over 7 weeks post-discharge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported 30-day smoking abstinence at 6 months post-randomization for AR+IVR participants compared to usual care. Additional outcomes include self-reported and biochemically-confirmed 7-day abstinence at 6 months, self-reported 7-day, 30-day, and continuous abstinence at 12 months, intervention dose response at 6- and 12-months for AR+IVR recipients, incremental cost-effectiveness of AR+IVR intervention compared to usual care at 6- and 12-months, and healthcare utilization and expenditures at 12-months for AR+IVR recipients compared to UC.DiscussionThis study will provide important evidence for the effectiveness and cost effectiveness of linking hospital-based tobacco treatment specialists’ services with discharge follow-up care.Trial Registration: ClinicalTrials.gov: NCT01236079.