Abstract TP385: Using a Learning Collaborative Model in Metro Chicago to Identify Best Practice Strategies for Emerging Topics: E-Cigarette Use in Stroke Patients

Background: National guidelines for stroke care recommend that patients discharged with a stroke who have a history of smoking receive smoking cessation intervention prior to hospital discharge. However, less is known about the types of intervention provided and subsequent outcomes post-discharge. The Metro Chicago Smoking Cessation Initiative Pilot aimed to improve understanding of smoking cessation interventions provided at discharge, smoking behavior at 30 days post-discharge, and best practices and barriers for reducing smoking rates in stroke patients discharged from 20 Chicago area hospitals. Methods: A review of smoking cessation interventions provided at discharge and smoking cessation outcomes post-discharge for stroke patients discharged between August 1, 2018 and July 31, 2019 at 20 Chicago area participating hospitals was conducted using Get With The Guidelines® Stroke. The pilot used a Learning Collaborative model that included a quality improvement leader, smoking cessation/health behavior content experts, reporting of experiences and data, and sharing of best practices. All hospitals were required to attend quarterly online learning sessions and use Get With The Guidelines® Stroke for data entry. Results: Preliminary results from the 20 participating hospitals suggest smoking cessation counseling is the most commonly delivered intervention at discharge. Of the patients reached at 30 days post-discharge, 75% of those who reported at history of smoking at the time of their stroke were still using tobacco products. However, nearly 50% of those patients reported having made at least one attempt to quit. Conclusions: Preliminary results from this pilot project highlight the need for improved tracking of smoking cessation interventions provided at discharge and associated smoking behavior post-discharge, as well as the benefits of regional collaboration for identifying and implementing best practices.

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Abstract 218: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.218 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Shyam Prabhakaran ◽

Renee M Sednew ◽

Kathleen O’Neill

Keyword(s):

Best Practices ◽

Performance Improvement ◽

Best Practice ◽

Learning Collaborative ◽

Collaborative Model ◽

Stroke Registry ◽

Chicago Area ◽

Regional Collaboration ◽

Content Expert ◽

And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

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Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867417692424 ◽

2017 ◽

Vol 51 (4) ◽

pp. 366-381 ◽

Cited By ~ 19

Author(s):

Alexandra P Metse ◽

John Wiggers ◽

Paula Wye ◽

Luke Wolfenden ◽

Megan Freund ◽

...

Keyword(s):

Smoking Cessation ◽

Randomised Controlled Trial ◽

Odds Ratio ◽

Controlled Trial ◽

Psychiatric Inpatient ◽

Point Prevalence ◽

Post Discharge ◽

Inpatient Psychiatry ◽

Cessation Intervention ◽

Randomised Controlled

Objective: Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours. Method: A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence. Results: Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls. Conclusions: Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.

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A Post-Discharge Smoking-Cessation Intervention for Hospital Patients

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2016.04.005 ◽

2016 ◽

Vol 51 (4) ◽

pp. 597-608 ◽

Cited By ~ 26

Author(s):

Nancy A. Rigotti ◽

Hilary A. Tindle ◽

Susan Regan ◽

Douglas E. Levy ◽

Yuchiao Chang ◽

...

Keyword(s):

Smoking Cessation ◽

Smoking Cessation Intervention ◽

Post Discharge ◽

Cessation Intervention ◽

Hospital Patients

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Development of a Self-Help Smoking Cessation Intervention for Dual Users of Tobacco Cigarettes and E-Cigarettes

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052328 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2328

Author(s):

Lauren R. Meltzer ◽

Vani N. Simmons ◽

Bárbara Piñeiro ◽

David J. Drobes ◽

Gwendolyn P. Quinn ◽

...

Keyword(s):

Smoking Cessation ◽

Phase I ◽

Phase Ii ◽

Electronic Cigarettes ◽

Smoking Cessation Intervention ◽

Cigarette Use ◽

Self Help ◽

Cessation Intervention ◽

Quitting Smoking ◽

Depth Interviews

Most users of electronic cigarettes (e-cigarettes) report initiating use to quit combustible cigarettes. Nevertheless, high levels of dual use (i.e., using both combustible cigarettes and e-cigarettes) occur among adults. Using formative data from in-depth interviews and employing learner verification, we adapted an existing, validated self-help smoking-cessation intervention (Stop Smoking for Good; SSFG) to create a targeted intervention for dual users, If You Vape: A Guide to Quitting Smoking (IYV). In Phase I, in-depth interviews (n = 28) were conducted to assess relevance of the existing SSFG materials (10 booklets, nine pamphlets) and identify new content for the booklets. Next, for Phase II, learner verification interviews (n = 20 dual users) were conducted to assess their appeal and acceptability. Several key themes emerged from the Phase I in-depth interviews. Findings led to the inclusion of e-cigarette-specific strategies used by successful quitters such as gradually reducing nicotine levels, switching from tobacco flavor to alternative flavors, and limiting e-cigarette use to places one would normally smoke (i.e., not expanding use). Suggestions from Phase II learner verification included broadening the visual appeal for a younger, more diverse demographic, expanding tips for quitting smoking via e-cigarettes, and expanding terminology for e-cigarette devices. Beginning with an efficacious self-help intervention, we used a systematic process to develop a version specifically for dual users.

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Abstract 101: A Learning Collaborative Model to Improve Door to Needle Time for Stroke Thrombolysis in Chicago

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.101 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Shyam Prabhakaran ◽

Kathleen O’Neill ◽

Keyword(s):

Best Practices ◽

Ct Scanner ◽

Learning Collaborative ◽

Collaborative Model ◽

Team Members ◽

Stroke Registry ◽

Face To Face ◽

Regional Collaboration ◽

Stroke Team ◽

Get With The Guidelines

Background: Door-to-needle (DTN) times have remained suboptimal despite overall increases in tissue plasminogen activator use (tPA) for stroke in Chicago. The American Heart Association’s (AHA) Quality Enhancement for Speedy Thrombolysis in Stroke (QUESTS) initiative aimed to identify barriers to reduce DTN times at Chicago’s 15 primary stroke centers (PSCs) and increase the proportion of patients treated with tPA within 60 minutes of hospital arrival. Methods: Starting in January 2013, we used face-to-face and on-site meetings with each PSC’s stroke team members to share AHA Target Stroke best practices and strategies to reduce DTN time. A survey of current practice was completed at each site to determine opportunities for improvement and repeated at 1 year to assess implementation of new strategies. We used the Get With The Guidelines (GWTG) Stroke registry to aggregate baseline data DTN times and track performance in each quarter of 2013. Results: At baseline, 5 strategies were notably under-utilized at Chicago’s 15 PSCs: 1) Direct to CT scanner (baseline: 0 sites; 1 year: 5 sites); 2) pre-mixing tPA (baseline: 1 site; 1 year: 14 sites); 3) tPA prior to laboratory results (baseline: 3 sites; 1 year: 7 sites); 4) stroke code activation at triage (baseline: 4 sites; 1 year: 13 sites); and 5) streamlined consent process (baseline: 0 sites; 1 year: 12 sites. The proportion of patients treated within 60 minutes increased in each quarter of 2013 from 25% in quarter 1 to 60% in quarter 4 (p<0.01). The median DTN time decreased from 89.5 minutes in quarter 1 to 55 minutes in quarter 4 (p<0.01). Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 15 PSCs in Chicago, we observed major improvements within a few months. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.

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Abstract 18789: A Learning Collaborative Model to Improve Door to Needle Time for Stroke Thrombolysis in Chicago

Circulation ◽

10.1161/circ.130.suppl_2.18789 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shyam Prabhakaran ◽

Kathleen O’Neill ◽

Keyword(s):

Best Practices ◽

Ct Scanner ◽

Learning Collaborative ◽

Collaborative Model ◽

Team Members ◽

Stroke Registry ◽

Face To Face ◽

Regional Collaboration ◽

Stroke Team ◽

Get With The Guidelines

Background: Door-to-needle (DTN) times have remained suboptimal despite overall increases in tissue plasminogen activator use (tPA) for stroke in Chicago. The American Heart Association’s (AHA) Quality Enhancement for Speedy Thrombolysis in Stroke (QUESTS) initiative aimed to identify barriers to reduce DTN times at Chicago’s 15 primary stroke centers (PSCs) and increase the proportion of patients treated with tPA within 60 minutes of hospital arrival. Methods: Starting in January 2013, we used face-to-face and on-site meetings with each PSC’s stroke team members to share AHA Target Stroke best practices and strategies to reduce DTN time. A survey of current practice was completed at each site to determine opportunities for improvement and repeated at 1 year to assess implementation of new strategies. We used the Get With The Guidelines (GWTG) Stroke registry to aggregate baseline data DTN times and track performance in each quarter of 2013. Results: At baseline, 5 strategies were notably under-utilized at Chicago’s 15 PSCs: 1) Direct to CT scanner (baseline: 0 sites; 1 year: 5 sites); 2) pre-mixing tPA (baseline: 1 site; 1 year: 14 sites); 3) tPA prior to laboratory results (baseline: 3 sites; 1 year: 7 sites); 4) stroke code activation at triage (baseline: 4 sites; 1 year: 13 sites); and 5) streamlined consent process (baseline: 0 sites; 1 year: 12 sites. The proportion of patients treated within 60 minutes increased in each quarter of 2013 from 25% in quarter 1 to 60% in quarter 4 (p<0.01). The median DTN time decreased from 89.5 minutes in quarter 1 to 55 minutes in quarter 4 (p<0.01). Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 15 PSCs in Chicago, we observed major improvements within a few months. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.

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Abstract TMP68: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

Stroke ◽

10.1161/str.48.suppl_1.tmp68 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Shyam Prabhakaran ◽

Renee M Sednew ◽

Kathleen O’Neill

Keyword(s):

Best Practices ◽

Performance Improvement ◽

Best Practice ◽

Learning Collaborative ◽

Collaborative Model ◽

Stroke Registry ◽

Chicago Area ◽

Regional Collaboration ◽

Content Expert ◽

And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

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Utilisation of Nicotine Replacement Therapy within a Hospital Pharmacist Initiated Smoking-Cessation Intervention – A Pragmatic Randomised Controlled Trial

The Journal of Smoking Cessation ◽

10.1017/jsc.2015.14 ◽

2015 ◽

Vol 12 (1) ◽

pp. 45-54 ◽

Cited By ~ 1

Author(s):

D. Gupta ◽

K. Winckel ◽

J. Burrows ◽

J. Ross ◽

J. W. Upham

Keyword(s):

Smoking Cessation ◽

Usual Care ◽

Replacement Therapy ◽

Nicotine Replacement Therapy ◽

Hospital Pharmacist ◽

Smoking Cessation Intervention ◽

Management Policy ◽

Post Discharge ◽

Nicotine Replacement ◽

Cessation Intervention

Introduction:Hospital pharmacists currently play a limited role in the management of nicotine withdrawal and smoking-cessation. They have multiple tasks and limited time; a strong evidence base is required to determine importance of including smoking-cessation interventions into their routine practice.Aims:The aims of this study were to evaluate the effectiveness of a hospital pharmacist initiated smoking-cessation intervention (SCI) in increasing the utilisation of Nicotine Replacement Therapy (NRT) in hospitalised smokers, and in increasing quit rates post-discharge.Methods:This study was conducted in a tertiary referral hospital using a pragmatic randomised control design. After screening, 100 inpatient smokers were enrolled and randomised by the research pharmacist (RP) to either the intervention or usual care arm (n= 50 for both arms). Smoking-cessation advice was available to all smokers during their hospital stay under the smoking management policy, which represented usual care. However, this approach is often unstructured and provided on an ad-hoc basis. Those in the intervention arm received brief SCI from the RP, who also facilitated NRT prescribing if required. Prescribing rates of NRT in the hospital and on discharge in both the groups were compared. Participants were contacted by phone three-months after enrolment to assess their seven-day point prevalence of abstinence (PPA) from smoking and use of NRT post-discharge.Results:A significantly higher proportion of participants in the intervention arm used NRT in the hospital (82% vs. 24%,Χ2= 33.8,p< 0.001) and at discharge (68% vs. 12%,Χ2= 32.7,p< 0.0001) and significantly more participants who received SCI from the RP continued to use NRT after discharge (OR 3.1, CI 1.2 to 8.2). A similar number of participants in both the groups claimed seven-day PPA after three-months (18% usual-care vs. 15% intervention-arm, OR 0.8, CI 0.24 to 2.67).Conclusions:Hospital pharmacist led brief SCI can enhance the utilisation of NRT in hospital and after discharge; there was no clear effect on cessation rates at three months. There is a need to explore feasible options for a coordinated, multidisciplinary approach to smoking-cessation in hospital and across the continuum, which may have a greater impact on long term smoking-cessation rates.

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