title: Referring Hospitalized Smokers to Outpatient Quit Services: A Randomized Trial.
abstract: Linking outpatient cessation services to bedside counseling for hospitalized smokers can improve long-run quit rates. Adding an assisted referral (AR) offer to a tobacco treatment specialist consult service fits the team approach to care in U.S. hospitals.
  
  
  
  A two-arm patient-randomized trial tested the effectiveness of adding an AR offer to outpatient smoking-cessation services and interactive voice recognition (AR+IVR) follow-up to a usual care (UC) tobacco-cessation consult for hospitalized smokers.
  
  
  
  Over 24 months (November 2011-November 2013), 898 hospitalized adult smokers interested in quitting smoking were recruited from three large hospitals in the Portland, Oregon, area: an integrated group model HMO (n=622), a community hospital (n=195), and an academic health center (n=81).
  
  
  
  Tobacco treatment specialists identified smokers and provided an intensive bedside tobacco use assessment and cessation consultation (UC). AR+IVR recipients also received proactive ARs to available outpatient counseling programs and medications, and linked patients to a tailored IVR telephone follow-up system.
  
  
  
  The primary outcome was self-reported 30-day abstinence at 6-month follow-up. Secondary outcomes included self-reported and continuous abstinence and biochemically confirmed 7-day abstinence at 6 months. Follow-up was completed in September 2014; data were analyzed in 2015.
  
  
  
  A total of 597 and 301 hospitalized smokers were randomized to AR+IVR and UC, respectively. AR+IVR and UC recipients received 19.3 and 17.0 minutes of bedside counseling (p=0.372), respectively. Most (58%) AR+IVR patients accepted referrals for counseling, 43% accepted medications, and 28% accepted both. Self-reported 30-day abstinence for AR+IVR (17.9%) and UC (17.3%) were not statistically significant (p=0.569). Differences in 7-day, continuous, and biochemically confirmed abstinence by treatment group also were insignificant, overall and adjusting for site.
  
  
  
  Adding an AR to outpatient counseling and medications did not increase cigarette abstinence at 6 months compared to UC alone.
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon. Electronic address: jeffrey.fellows@kpchr.org.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Fellows
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mularski
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Leo
authors.affiliation: Tobacco Cessation and Prevention, Legacy Health System, Portland, Oregon;
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Bentz
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Waiwaiole
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Melanie C
authors.initials: MC
authors.lastname: Francisco
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Funkhouser
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Stoney
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration*; D016540:Smoking Cessation / Q000706:statistics & numerical data*