Implementation of HIT-Enhanced Tobacco Treatment for Hospitalized Smokers

• Sponsor: Yale University (Other)
• Overall Status: Completed
• CT.gov ID: NCT01691105
• Collaborator: National Heart, Lung, and Blood Institute (NHLBI) (NIH), National Institutes of Health (NIH) (NIH)
• Enrollment: 1,044
• Location: 1
• Arms: 2
• Duration (Months): 37
• Patients Per Site Per Month: 28.2

Study Details

Study Description

Brief Summary

This study will implement and test the effectiveness and cost-effectiveness of a tobacco cessation intervention (Academic Detailing + Integrated Tobacco Order Set - AD + ITOS) for adults admitted to the hospital. The intervention will begin during the hospital stay and continue after discharge. The intervention will use resources easily available to most acute care hospitals: computerized physician order entry, physician and nurse education, staff meetings for physicians, nurses and allied health professionals, online learning capabilities, faxing to primary care providers (PCPs), and the telephone counseling and support available from a state smokers' quitline (QL).

The investigators hypothesize that the subjects in the intervention arm (AD + ITOS) will be more likely to achieve tobacco abstinence at 12 months post hospital stay than subjects in the control arm (Academic Detailing - AD). Tobacco abstinence will be assessed by self report and biochemical verification (exhaled carbon monoxide reading).

Condition or Disease	Intervention/Treatment	Phase
Tobacco Use Cessation; Smoking Cessation; Smoking; Tobacco Use Disorder	Other: AD + Integrated Tobacco Order Set	N/A

Detailed Description

Cigarette smoking remains the leading cause of preventable death and illness in the United States. In 2008, 20.6% of all American adults smoked, and 435,000 died from smoking-related illnesses. Economic costs of smoking dependence are estimated at $193 billion/year and have far-reaching implications for the individual, workplace, society and the healthcare system. However, treatment is associated with significant individual and society benefits, and both counseling and pharmacotherapy have been demonstrated to be effective treatments. Along with poverty and low education, smoking causes a greater loss of quality-adjusted life years than race, uninsurance, overweight, or binge drinking.

Smokers are admitted to acute care hospital more than nonsmokers. Using estimates from a number of sources, we estimate that approximately 6.1-12.5 million hospitalizations occur annually among adult smokers. This represents 20-41% of the 29.8 million annual inpatient stays in US acute care hospitals among adults age 18 and older unrelated to pregnancy or childbirth. Put another way, the nation's 46 million smokers represent 20% of the adult population, but account for 20-40% of all hospitalizations unrelated to pregnancy. Given that US hospitals are now smoke-free (per Joint Commission regulations), and many of these admissions are for tobacco-related conditions, the hospital admission represents a profound opportunity-a "teachable moment"-for tobacco control.

Recent "core measure" regulations by the Joint Commission and the Centers for Medicare and Medicaid Services require hospitals to report publicly their tobacco screening for patients admitted with acute myocardial infarction, congestive heart failure, and pneumonia. Although many hospitals have improved their performance considerably on these smoking measures, sometimes this has resulted from "gaming," e.g. giving all discharged patients a preprinted instruction sheet that includes boilerplate text about smoking cessation. Thus, although most hospitals assess inpatients for tobacco use (either through a nursing assessment or the physician's initial history and physical examination), there are often no systems in place to initiate or sustain tobacco treatment for smokers. This gap in service delivery prevents millions of smokers from accessing the many effective, evidence-based treatments for tobacco dependence during a period in which they may be particularly receptive to an intervention.

Hence, the overarching goal of this project is to implement and study the effectiveness and cost-effectiveness of a tobacco intervention for hospitalized adults that begins during inpatient treatment and continues after discharge. To enhance dissemination, we will use resources currently available to most acute care hospitals: computerized physician order entry, physician and nurse education, staff meetings for physicians, nurses, and allied health professionals, online learning capabilities, faxing to primary care providers (PCPs), and the telephone counseling and support available from a state smokers' quitline (QL). In the final year, a toolkit will be disseminated by professional societies. We hypothesize that the proposed intervention is clinically effective, cost effective, sustainable, and generalizable. All interventions are evidence-based and consistent with the 2008 Public Health Service clinical practice guideline for tobacco dependence treatment.

The Specific Aims of the proposed project are to:

Primary Aims:

1. Determine whether Academic Detailing (AD) and an Integrated Tobacco Order Set (ITOS) compared to AD alone improves biologically verified smoking cessation at 12 months post-quit in a cohort of 960 smokers age > 18 years admitted to Yale New Haven Hospital (YNHH).

Secondary Aims:

1. Study ITOS's ability to encourage smokers to use treatment services and reduce consumption.

2. Study ITOS's ability to enhance provider delivery of tobacco screening and treatment.

3. Conduct an incremental cost-effectiveness analysis of the intervention.

Our associated hypotheses are:

1. Subjects treated by physicians in the AD+ITOS arm will have a higher rate of biochemically verified 7-day point prevalence smoking abstinence at 12 months post-quit than subjects treated by physicians in the AD arm, in a cohort of adult smokers admitted to the inpatient units of Yale-New Haven Hospital.

2. Subjects treated by AD+ITOS physicians will have made more quit attempts, and experienced greater reduction in daily cigarette consumption, than smokers treated by AD physicians.

3. A higher proportion of patients treated by AD+ITOS physicians will have tobacco treatment initiated in hospital than patients treated by AD physicians.

4. Societal costs of AD+ITOS, per abstinent smoker, will be cost-effective relative to AD.

Study Design

• Study Type: Interventional
• Actual Enrollment: 1044 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Investigator)
• Primary Purpose: Treatment
• Official Title: Implementation of HIT-Enhanced Tobacco Treatment for Hospitalized Smokers
• Study Start Date: Aug 1, 2013
• Actual Primary Completion Date: Sep 1, 2016
• Actual Study Completion Date: Sep 1, 2016

Arms and Interventions

Arm	Intervention/Treatment
No Intervention: Academic Detailing (AD) Standard of care for patients who are smokers and admitted to the hospital.
Experimental: AD + Integrated Tobacco Order Set Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center	Other: AD + Integrated Tobacco Order Set; Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center

Outcome Measures

Primary Outcome Measures

1. Number of Participants With Exhaled Carbon Monoxide Confirmed Abstinence [12 months post enrollment]

   Tobacco abstinence will be assessed by obtaining an exhaled carbon monoxide reading for all subjects self-reporting tobacco abstinence at 12 month follow-up. Consistent with manufacturer's recommendations, a cutoff of 10 ppm will indicate current smoking.

Secondary Outcome Measures

1. Number of Participants With Self-Reported Tobacco Reduction or Abstinence - 12 Months [12 months post enrollment]

   Self-report questionnaires are completed over the phone to assess reduction in cigarette use or abstinence from cigarette use. The Time Line Follow Back technique will be used to assess 7-day point prevalence abstinence.

2. Number of Participants With Self-Reported Tobacco Reduction or Abstinence - 6 Months [6 months post enrollment]

   Self-report questionnaires are completed over the phone to assess reduction in cigarette use or abstinence from cigarette use. The Time Line Follow Back technique will be used to assess 7-day point prevalence abstinence.

3. Number of Participants With Self-Reported Tobacco Reduction or Abstinence - 1 Month [1 month post enrollment]

   Self-report questionnaires are completed over the phone to assess reduction in cigarette use or abstinence from cigarette use. The Time Line Follow Back technique will be used to assess 7-day point prevalence abstinence.

4. Number of Participants Self-Reporting Use of Cessation Medications - 1 Month [1 month post enrollment]

   Nicotine replacement therapy (NRT) use and use of other pharmacotherapies will be assessed by self-report. A Treatment Services Review (TSR) will be administered during follow-up assessments at 1, 6, and 12 months post enrollment.

5. Number of Participants Self-Reporting Use of Cessation Medications - 6 Months [6 months post enrollment]

   NRT use and use of other pharmacotherapies will be assessed by self-report. A Treatment Services Review (TSR) will be administered during follow-up assessments at 6 months post enrollment.

6. Number of Participants Self-Reporting Use of Cessation Medications - 12 Months [12 months post enrollment]

   NRT use and use of other pharmacotherapies will be assessed by self-report. A Treatment Services Review (TSR) will be administered during follow-up assessments at 1, 6, and 12 months post enrollment.

7. Number of Participants Self-Reporting Treatment Engagement - 1 Month [1 month post enrollment]

   Treatment engagement will be assessed by subject self-report during the 1 month follow-up interview. Subjects will be considered engaged in treatment if at 30 days after randomization the subject reports currently receiving care for the Quitline or another treatment program that addresses the subject's nicotine dependence.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• 18 years or older

• admitted to any medical ward, telemetry or cardiac care unit

• identified as a smoker by the nurse or physician in the admitting EMR

• treated by a study physician

• able to give written informed consent

Exclusion Criteria:

• inability to read or understand English or Spanish

• lacks capacity to give informed consent

• currently receiving formal tobacco dependence treatment

• current suicide or homicide risk

• current psychotic disorder or life-threatening or unstable medical or psychiatric condition within past 6 months

• unable to provide 2 telephone contact numbers

• unwilling to follow up per study protocol, including release of information to assess treatment engagement at 30-days

• live outside of New Haven County

• leaving the hospital against medical advice

• history of clinically significant allergic reaction to nicotine replacement therapies, varenicline or bupropion

• use of an investigational drug within 30 days

• use of tobacco products other than cigarettes

• women of childbearing potential who are pregnant, nursing, or sexually active and not practicing effective contraception (oral injectable, or implantable contraceptives, intrauterine device, or barrier method with spermicide)

• do not have access to a phone with a CT area code (required to use the CT Tobacco Quitline)

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Yale University	New Haven	Connecticut	United States	06510

Sponsors and Collaborators

• Yale University
• National Heart, Lung, and Blood Institute (NHLBI)
• National Institutes of Health (NIH)

Investigators

• Principal Investigator: Steven L Bernstein, MD, Yale University

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Yale University
• ClinicalTrials.gov Identifier: NCT01691105
• Other Study ID Numbers: 1205010297; R18HL108788
• First Posted: Sep 24, 2012
• Last Update Posted: Sep 5, 2021
• Last Verified: Aug 1, 2021

• Keywords provided by Yale University: Tobacco Use Cessation; Smoking Cessation; Nicotine Replacement Therapy; Hospitalized Smokers
• Additional relevant MeSH terms: Tobacco Use Disorder

Study Results

Participant Flow

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
Period Title: Baseline
STARTED	477	567
COMPLETED	477	567
NOT COMPLETED	0	0
Period Title: Baseline
STARTED	477	567
COMPLETED	434	526
NOT COMPLETED	43	41
Period Title: Baseline
STARTED	477	567
COMPLETED	425	496
NOT COMPLETED	52	71
Period Title: Baseline
STARTED	477	567
COMPLETED	405	466
NOT COMPLETED	72	101
Period Title: Baseline
STARTED	477	567
COMPLETED	53	65
NOT COMPLETED	424	502

Baseline Characteristics

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set	Total
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center	Total of all reporting groups
Overall Participants	477	567	1044
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	49.3 (12.6)	49.3 (11.7)	49.3 (12.1)
Sex: Female, Male (Count of Participants)
Female	238 49.9%	286 50.4%	524 50.2%
Male	239 50.1%	281 49.6%	520 49.8%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	51 10.7%	61 10.8%	112 10.7%
Not Hispanic or Latino	426 89.3%	506 89.2%	932 89.3%
Unknown or Not Reported	0 0%	0 0%	0 0%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	4 0.8%	1 0.2%	5 0.5%
Asian	2 0.4%	3 0.5%	5 0.5%
Native Hawaiian or Other Pacific Islander	0 0%	0 0%	0 0%
Black or African American	157 32.9%	170 30%	327 31.3%
White	303 63.5%	372 65.6%	675 64.7%
More than one race	11 2.3%	18 3.2%	29 2.8%
Unknown or Not Reported	0 0%	3 0.5%	3 0.3%
Region of Enrollment (participants) [Number]
United States	477 100%	567 100%	1044 100%
Cigarettes/day (cigarettes per day) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [cigarettes per day]	10.0	10.5	10.0
Heavy Smoking Index >= 4, N (%) (Count of Participants)
Count of Participants [Participants]	208 43.6%	210 37%	418 40%

Outcome Measures

1. Primary Outcome

Title	Number of Participants With Exhaled Carbon Monoxide Confirmed Abstinence
Description	Tobacco abstinence will be assessed by obtaining an exhaled carbon monoxide reading for all subjects self-reporting tobacco abstinence at 12 month follow-up. Consistent with manufacturer's recommendations, a cutoff of 10 ppm will indicate current smoking.
Time Frame	12 months post enrollment

Outcome Measure Data

Analysis Population Description

Only participants self-reporting abstinence during the 12 month follow-up call were asked to provide biochemical verification.

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
Measure Participants	78	86
Number [participants]	53 11.1%	65 11.5%

2. Secondary Outcome

Title	Number of Participants With Self-Reported Tobacco Reduction or Abstinence - 12 Months
Description	Self-report questionnaires are completed over the phone to assess reduction in cigarette use or abstinence from cigarette use. The Time Line Follow Back technique will be used to assess 7-day point prevalence abstinence.
Time Frame	12 months post enrollment

Outcome Measure Data

Analysis Population Description

Only includes participants who completed the 12 month follow-up appointment.

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
Measure Participants	405	466
Number [participants]	78 16.4%	86 15.2%

3. Secondary Outcome

Title	Number of Participants With Self-Reported Tobacco Reduction or Abstinence - 6 Months
Description	Self-report questionnaires are completed over the phone to assess reduction in cigarette use or abstinence from cigarette use. The Time Line Follow Back technique will be used to assess 7-day point prevalence abstinence.
Time Frame	6 months post enrollment

Outcome Measure Data

Analysis Population Description

Includes only participants who completed the 6 month follow-up appointment.

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
Measure Participants	425	496
Number [participants]	68 14.3%	83 14.6%

4. Secondary Outcome

Title	Number of Participants With Self-Reported Tobacco Reduction or Abstinence - 1 Month
Description	Self-report questionnaires are completed over the phone to assess reduction in cigarette use or abstinence from cigarette use. The Time Line Follow Back technique will be used to assess 7-day point prevalence abstinence.
Time Frame	1 month post enrollment

Outcome Measure Data

Analysis Population Description

Includes only participants who completed 1 month follow-up appointment.

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
Measure Participants	434	526
Number [participants]	72 15.1%	87 15.3%

5. Secondary Outcome

Title	Number of Participants Self-Reporting Use of Cessation Medications - 1 Month
Description	Nicotine replacement therapy (NRT) use and use of other pharmacotherapies will be assessed by self-report. A Treatment Services Review (TSR) will be administered during follow-up assessments at 1, 6, and 12 months post enrollment.
Time Frame	1 month post enrollment

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
Measure Participants	434	526
Count of Participants [Participants]	126 26.4%	187 33%

6. Secondary Outcome

Title	Number of Participants Self-Reporting Use of Cessation Medications - 6 Months
Description	NRT use and use of other pharmacotherapies will be assessed by self-report. A Treatment Services Review (TSR) will be administered during follow-up assessments at 6 months post enrollment.
Time Frame	6 months post enrollment

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
Measure Participants	425	496
Count of Participants [Participants]	100 21%	146 25.7%

7. Secondary Outcome

Title	Number of Participants Self-Reporting Use of Cessation Medications - 12 Months
Description	NRT use and use of other pharmacotherapies will be assessed by self-report. A Treatment Services Review (TSR) will be administered during follow-up assessments at 1, 6, and 12 months post enrollment.
Time Frame	12 months post enrollment

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
Measure Participants	405	466
Count of Participants [Participants]	100 21%	136 24%

8. Secondary Outcome

Title	Number of Participants Self-Reporting Treatment Engagement - 1 Month
Description	Treatment engagement will be assessed by subject self-report during the 1 month follow-up interview. Subjects will be considered engaged in treatment if at 30 days after randomization the subject reports currently receiving care for the Quitline or another treatment program that addresses the subject's nicotine dependence.
Time Frame	1 month post enrollment

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Academic Detailing (AD)	AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.	Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
Measure Participants	434	526
Count of Participants [Participants]	32 6.7%	80 14.1%

Adverse Events

Adverse Event Reporting Description	All-Cause Mortality, Serious, and Other [Not Including Serious] Adverse Events were not monitored/assessed.
Arm/Group Title	Academic Detailing (AD)		AD + Integrated Tobacco Order Set
Arm/Group Description	Standard of care for patients who are smokers and admitted to the hospital.		Access to the Integrated Tobacco Order Set (ITOS) Nicotine Replacement Therapy with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center AD + Integrated Tobacco Order Set: Physician will have access to: NRT with dosing instructions Bupropion and varenicline with dosing instructions Automated referral to the CT Quitline Automated fax to PCP Discharge prescription prompt Quitline report sent to PCP 2 day call back from hospital call center
All Cause Mortality
	Academic Detailing (AD)		AD + Integrated Tobacco Order Set
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)
Serious Adverse Events
	Academic Detailing (AD)		AD + Integrated Tobacco Order Set
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)
Other (Not Including Serious) Adverse Events
	Academic Detailing (AD)		AD + Integrated Tobacco Order Set
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.