Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART)

Sonia A. Duffy, Sharon E. Cummins, Jeffrey L. Fellows, Kathleen F. Harrington, Carrie Kirby, Erin Rogers, Taneisha S. Scheuermann, Hilary A. Tindle, Andrea H. Waltje, David Ronis, Lee Ewing, Shu Hong Zhu, Kimberly Richter, Scott Sherman, William Bailey, Lisa Waiwaiole, Nancy Rigotti

Research output: Contribution to journalArticle

Abstract

Background: This paper describes fidelity monitoring (treatment differentiation, training, delivery, receipt and enactment) across the seven National Institutes of Health-supported Consortium of Hospitals Advancing Research on Tobacco (CHART) studies. The objectives of the study were to describe approaches to monitoring fidelity including treatment differentiation (lack of crossover), provider training, provider delivery of treatment, patient receipt of treatment, and patient enactment (behavior) and provide examples of application of these principles. Methods: Conducted between 2010 and 2014 and collectively enrolling over 9500 inpatient cigarette smokers, the CHART studies tested different smoking cessation interventions (counseling, medications, and follow-up calls) shown to be efficacious in Cochrane Collaborative Reviews. The CHART studies compared their unique treatment arm(s) to usual care, used common core measures at baseline and 6-month follow-up, but varied in their approaches to monitoring the fidelity with which the interventions were implemented. Results: Treatment differentiation strategies included the use of a quasi-experimental design and monitoring of both the intervention and control group. Almost all of the studies had extensive training for personnel and used a checklist to monitor the intervention components, but the items on these checklists varied widely and were based on unique aspects of the interventions, US Public Health Service and Joint Commission smoking cessation standards, or counselor rapport. Delivery of medications ranged from 31 to 100 % across the studies, with higher levels from studies that gave away free medications and lower levels from studies that sought to obtain prescriptions for the patient in real world systems. Treatment delivery was highest among those studies that used automated (interactive voice response and website) systems, but this did not automatically translate into treatment receipt and enactment. Some studies measured treatment enactment in two ways (e.g., counselor or automated system report versus patient report) showing concurrence or discordance between the two measures. Conclusion: While fidelity monitoring can be challenging especially in dissemination trials, the seven CHART studies used a variety of methods to enhance fidelity with consideration for feasibility and sustainability. Trial registration: Dissemination of Tobacco Tactics for hospitalized smokers. Clinical Trials Registration No. NCT01309217. Smoking cessation in hospitalized smokers. Clinical Trials Registration No. NCT01289275. Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Clinical Trials Registration No. NCT01305928. Web-based smoking cessation intervention that transitions from inpatient to outpatient. Clinical Trials Registration No. NCT01277250. Effectiveness of smoking-cessation interventions for urban hospital patients. Clinical Trials Registration No. NCT01363245. Comparative effectiveness of post-discharge interventions for hospitalized smokers. Clinical Trials Registration No. NCT01177176. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals. Clinical Trials Registration No. NCT01236079.

Original languageEnglish (US)
Article number29
JournalTobacco Induced Diseases
Volume13
Issue number1
DOIs
StatePublished - Sep 3 2015

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nicotine
Tobacco
monitoring
Smoking Cessation
Clinical Trials
Research
smoking
medication
Therapeutics
Checklist
counselor
Inpatients
Outpatients
Tobacco Use Cessation
public health services
United States Public Health Service
Urban Hospitals
National Institutes of Health (U.S.)
health
Tobacco Products

Keywords

  • Cessation
  • Fidelity
  • Inpatient
  • Smoking

ASJC Scopus subject areas

  • Health(social science)
  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health

Cite this

Duffy, S. A., Cummins, S. E., Fellows, J. L., Harrington, K. F., Kirby, C., Rogers, E., ... Rigotti, N. (2015). Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART). Tobacco Induced Diseases, 13(1), [29]. https://doi.org/10.1186/s12971-015-0056-5

Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART). / Duffy, Sonia A.; Cummins, Sharon E.; Fellows, Jeffrey L.; Harrington, Kathleen F.; Kirby, Carrie; Rogers, Erin; Scheuermann, Taneisha S.; Tindle, Hilary A.; Waltje, Andrea H.; Ronis, David; Ewing, Lee; Zhu, Shu Hong; Richter, Kimberly; Sherman, Scott; Bailey, William; Waiwaiole, Lisa; Rigotti, Nancy.

In: Tobacco Induced Diseases, Vol. 13, No. 1, 29, 03.09.2015.

Research output: Contribution to journalArticle

Duffy, SA, Cummins, SE, Fellows, JL, Harrington, KF, Kirby, C, Rogers, E, Scheuermann, TS, Tindle, HA, Waltje, AH, Ronis, D, Ewing, L, Zhu, SH, Richter, K, Sherman, S, Bailey, W, Waiwaiole, L & Rigotti, N 2015, 'Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART)', Tobacco Induced Diseases, vol. 13, no. 1, 29. https://doi.org/10.1186/s12971-015-0056-5
Duffy, Sonia A. ; Cummins, Sharon E. ; Fellows, Jeffrey L. ; Harrington, Kathleen F. ; Kirby, Carrie ; Rogers, Erin ; Scheuermann, Taneisha S. ; Tindle, Hilary A. ; Waltje, Andrea H. ; Ronis, David ; Ewing, Lee ; Zhu, Shu Hong ; Richter, Kimberly ; Sherman, Scott ; Bailey, William ; Waiwaiole, Lisa ; Rigotti, Nancy. / Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART). In: Tobacco Induced Diseases. 2015 ; Vol. 13, No. 1.
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AU - Duffy, Sonia A.

AU - Cummins, Sharon E.

AU - Fellows, Jeffrey L.

AU - Harrington, Kathleen F.

AU - Kirby, Carrie

AU - Rogers, Erin

AU - Scheuermann, Taneisha S.

AU - Tindle, Hilary A.

AU - Waltje, Andrea H.

AU - Ronis, David

AU - Ewing, Lee

AU - Zhu, Shu Hong

AU - Richter, Kimberly

AU - Sherman, Scott

AU - Bailey, William

AU - Waiwaiole, Lisa

AU - Rigotti, Nancy

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N2 - Background: This paper describes fidelity monitoring (treatment differentiation, training, delivery, receipt and enactment) across the seven National Institutes of Health-supported Consortium of Hospitals Advancing Research on Tobacco (CHART) studies. The objectives of the study were to describe approaches to monitoring fidelity including treatment differentiation (lack of crossover), provider training, provider delivery of treatment, patient receipt of treatment, and patient enactment (behavior) and provide examples of application of these principles. Methods: Conducted between 2010 and 2014 and collectively enrolling over 9500 inpatient cigarette smokers, the CHART studies tested different smoking cessation interventions (counseling, medications, and follow-up calls) shown to be efficacious in Cochrane Collaborative Reviews. The CHART studies compared their unique treatment arm(s) to usual care, used common core measures at baseline and 6-month follow-up, but varied in their approaches to monitoring the fidelity with which the interventions were implemented. Results: Treatment differentiation strategies included the use of a quasi-experimental design and monitoring of both the intervention and control group. Almost all of the studies had extensive training for personnel and used a checklist to monitor the intervention components, but the items on these checklists varied widely and were based on unique aspects of the interventions, US Public Health Service and Joint Commission smoking cessation standards, or counselor rapport. Delivery of medications ranged from 31 to 100 % across the studies, with higher levels from studies that gave away free medications and lower levels from studies that sought to obtain prescriptions for the patient in real world systems. Treatment delivery was highest among those studies that used automated (interactive voice response and website) systems, but this did not automatically translate into treatment receipt and enactment. Some studies measured treatment enactment in two ways (e.g., counselor or automated system report versus patient report) showing concurrence or discordance between the two measures. Conclusion: While fidelity monitoring can be challenging especially in dissemination trials, the seven CHART studies used a variety of methods to enhance fidelity with consideration for feasibility and sustainability. Trial registration: Dissemination of Tobacco Tactics for hospitalized smokers. Clinical Trials Registration No. NCT01309217. Smoking cessation in hospitalized smokers. Clinical Trials Registration No. NCT01289275. Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Clinical Trials Registration No. NCT01305928. Web-based smoking cessation intervention that transitions from inpatient to outpatient. Clinical Trials Registration No. NCT01277250. Effectiveness of smoking-cessation interventions for urban hospital patients. Clinical Trials Registration No. NCT01363245. Comparative effectiveness of post-discharge interventions for hospitalized smokers. Clinical Trials Registration No. NCT01177176. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals. Clinical Trials Registration No. NCT01236079.

AB - Background: This paper describes fidelity monitoring (treatment differentiation, training, delivery, receipt and enactment) across the seven National Institutes of Health-supported Consortium of Hospitals Advancing Research on Tobacco (CHART) studies. The objectives of the study were to describe approaches to monitoring fidelity including treatment differentiation (lack of crossover), provider training, provider delivery of treatment, patient receipt of treatment, and patient enactment (behavior) and provide examples of application of these principles. Methods: Conducted between 2010 and 2014 and collectively enrolling over 9500 inpatient cigarette smokers, the CHART studies tested different smoking cessation interventions (counseling, medications, and follow-up calls) shown to be efficacious in Cochrane Collaborative Reviews. The CHART studies compared their unique treatment arm(s) to usual care, used common core measures at baseline and 6-month follow-up, but varied in their approaches to monitoring the fidelity with which the interventions were implemented. Results: Treatment differentiation strategies included the use of a quasi-experimental design and monitoring of both the intervention and control group. Almost all of the studies had extensive training for personnel and used a checklist to monitor the intervention components, but the items on these checklists varied widely and were based on unique aspects of the interventions, US Public Health Service and Joint Commission smoking cessation standards, or counselor rapport. Delivery of medications ranged from 31 to 100 % across the studies, with higher levels from studies that gave away free medications and lower levels from studies that sought to obtain prescriptions for the patient in real world systems. Treatment delivery was highest among those studies that used automated (interactive voice response and website) systems, but this did not automatically translate into treatment receipt and enactment. Some studies measured treatment enactment in two ways (e.g., counselor or automated system report versus patient report) showing concurrence or discordance between the two measures. Conclusion: While fidelity monitoring can be challenging especially in dissemination trials, the seven CHART studies used a variety of methods to enhance fidelity with consideration for feasibility and sustainability. Trial registration: Dissemination of Tobacco Tactics for hospitalized smokers. Clinical Trials Registration No. NCT01309217. Smoking cessation in hospitalized smokers. Clinical Trials Registration No. NCT01289275. Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Clinical Trials Registration No. NCT01305928. Web-based smoking cessation intervention that transitions from inpatient to outpatient. Clinical Trials Registration No. NCT01277250. Effectiveness of smoking-cessation interventions for urban hospital patients. Clinical Trials Registration No. NCT01363245. Comparative effectiveness of post-discharge interventions for hospitalized smokers. Clinical Trials Registration No. NCT01177176. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals. Clinical Trials Registration No. NCT01236079.

KW - Cessation

KW - Fidelity

KW - Inpatient

KW - Smoking

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