| Institution: | 1.College of Nursing,Ohio State University,Columbus,USA;2.Veterans Affairs (VA) Center for Clinical Management Research,HSR&D Center of Excellence,Ann Arbor,USA;3.University of Michigan School of Nursing,Ann Arbor,USA;4.VA Center for Clinical Management Research,HSR&D Center of Excellence,Ann Arbor,USA;5.Internal Medicine, Brehm Tower,University of Michigan,Ann Arbor,USA;6.Trinity Health,Livonia,USA;7.The Lacks Cancer Center, Mercy Health Saint Mary’s,Grand Rapids,USA;8.Mercy Health Partners,Muskegon,USA;9.Saint Joseph Mercy Health System,Ann Arbor,USA;10.Saint Mary Mercy Hospital,Livonia,USA;11.Department of Psychiatry and Behavioral Sciences,Northwestern University, Feinberg School of Medicine,Chicago,USA;12.Center for Management of Complex Chronic Care,Hines VA Hospital,Hines,USA;13.Dartmouth-Hitchcock Medical Center,Lebanon,USA |
| Abstract: | BackgroundGuided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework.MethodsThis pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention.Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended).ResultsReach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n?=?1370, p?<?0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n?=?1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p?<?0.05) and reported decreased barriers to implementing smoking cessation services (p?<?0.001). Qualitative comments were very positive (“user friendly,” “streamlined,” or “saves time”), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended.ConclusionsGiven that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation. |
