Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals.
Guided 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.



This 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).



Reach: 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.



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.



Given 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.



ClinicalTrials.gov, NCT01309217.
College of Nursing, Ohio State University, Newton Hall, 1585 Neil Ave, Columbus, OH, 43210, USA. Duffy.278@osu.edu.|Veterans Affairs (VA) Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA. Duffy.278@osu.edu.
Sonia A
SA
Duffy
University of Michigan School of Nursing, 400 North Ingalls Building Room 4330, Ann Arbor, MI, 48109-0482, USA.
David L
DL
Ronis
VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
Lee A
LA
Ewing
Internal Medicine, Brehm Tower, University of Michigan, Room 6115, 1000 Wall Street, Ann Arbor, MI, 48109-5714, USA.
Andrea H
AH
Waltje
VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
Stephanie V
SV
Hall
Trinity Health, 20555 Victor Parkway, Livonia, MI, 48152, USA.
Patricia L
PL
Thomas
The Lacks Cancer Center, Mercy Health Saint Mary's, 200 Jefferson SE, Grand Rapids, MI, 49503, USA.
Christine M
CM
Olree
Mercy Health Partners, 1500 Sherman Blvd., Muskegon, MI, 49444, USA.
Kimberly A
KA
Maguire
Saint Joseph Mercy Health System, 5305 E. Huron River Dr., Ann Arbor, MI, 48106-0995, USA.
Lisa
L
Friedman
Saint Mary Mercy Hospital, 36475 Five Mile Road, Livonia, MI, 48154-1988, USA.
Sue
S
Klotz
Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Abbott Hall 710 North Lake Shore Drive, Suite 904, Chicago, IL, 60611, USA.|Center for Management of Complex Chronic Care, Hines VA Hospital, 5000 S 5th Ave., Hines, IL, 60141, USA.
Neil
N
Jordan
Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH, 03756, USA.
Gay L
GL
Landstrom
D001291:Attitude of Health Personnel; D000073865:Cigarette Smoking; D003376:Counseling; D003695:Delivery of Health Care; D005260:Female; D006293:Health Promotion / Q000379:methods; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000379:methods*; D010358:Patient Participation / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses'; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention / Q000379:methods*; D017216:Telemedicine / Q000379:methods
Cessation; Inpatient; Smoking