The implementation of ask-advise-connect in a federally qualified health center: a mixed methods evaluation using the re-aim framework

Bethany Shorey Fennell; Cherell Cottrell-Daniels; Diana Stewart Hoover; Claire A. Spears; Nga Nguyen; Bárbara Piñeiro; Lorna H. McNeill; David W. Wetter; Damon J. Vidrine; Jennifer I. Vidrine

doi:10.1093/tbm/ibad007

The implementation of ask-advise-connect in a federally qualified health center: a mixed methods evaluation using the re-aim framework

Bethany Shorey Fennell, Cherell Cottrell-Daniels, Diana Stewart Hoover, Claire A. Spears, Nga Nguyen, Bárbara Piñeiro, Lorna H. McNeill, David W. Wetter, Damon J. Vidrine, Jennifer I. Vidrine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Ask-Advise-Connect (AAC) efficiently links smokers in healthcare settings with evidence-based Quitline-delivered tobacco treatment through training clinic staff to systematically ask patients about smoking status, advise smokers to quit, and connect patients with state Quitlines using the electronic health record. This study utilized a mixed-methods approach, guided by the RE-AIM framework, to evaluate the implementation of AAC in a Federally Qualified Health Center (FQHC). AAC was implemented for 18 months at a FQHC serving primarily low-socioeconomic status (SES) Latinos and Latinas. Results are presented within the RE-AIM conceptual framework which includes dimensions of reach, effectiveness, adoption, implementation, and maintenance. Quantitative patient-level outcomes of reach, effectiveness, and Impact were calculated. Post-implementation, in-depth interviews were conducted with clinic leadership and staff (N = 9) to gather perceptions and inform future implementation efforts. During the implementation period, 12.0% of GNHC patients who reported current smoking both agreed to have their information sent to the Quitline and were successfully contacted by the Quitline (Reach), 94.8% of patients who spoke with the Quitline enrolled in treatment (Effectiveness), and 11.4% of all identified smokers enrolled in Quitline treatment (Impact). In post-implementation interviews assessing RE-AIM dimensions, clinic staff and leadership identified facilitators and advantages of AAC and reported that AAC was easy to learn and implement, streamlined existing procedures, and had a positive impact on patients. Staff and leadership reported enthusiasm about AAC implementation and believed AAC fit well in the clinic. Staff were interested in AAC becoming the standard of care and made suggestions for future implementation. Clinic staff at a FQHC serving primarily low-SES Latinos and Latinas viewed the ACC implementation process positively. Findings have implications for streamlining clinical smoking cessation procedures and the potential to reduce tobacco-related disparities.

Original language	English
Pages (from-to)	551-560
Number of pages	10
Journal	Translational Behavioral Medicine
Volume	13
Issue number	8
DOIs	https://doi.org/10.1093/tbm/ibad007
State	Published - Aug 1 2023

Bibliographical note

Publisher Copyright:
© Society of Behavioral Medicine 2023. All rights reserved.

Funding

This research is supported by a grant from: the Cancer Prevention and Research Institute of Texas [PP110171; PI: JIV]; the Oklahoma Tobacco Settlement Endowment Trust [092-016-0002; PI: JIV]; the National Cancer Institute to the University of Texas MD Anderson Cancer Center as a Cancer Center Support Grant [P30CA016672; PI: Pisters]; the National Cancer Institute to the Stephenson Cancer Center as a Cancer Center Support Grant [P30CA225520; PI: Mannel]; the National Cancer Institute to Moffitt Cancer Center as a Cancer Center Support Grant [P30CA076292; PI: Cleveland]; the National Institute on Drug Abuse [K23 DA040933; PI: DSH]; and the National Center for Complementary and Integrative Health [K23AT008442; PI: CAS]; and the National Institutes of Health Training Grant in Behavioral Oncology [T32CA090314-18, PIs: Brandon, Vadaparampil; trainees: BSF, CCD]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funders	Funder number
National Institutes of Health (NIH)	T32CA090314-18
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse	K23 DA040933
National Childhood Cancer Registry – National Cancer Institute
Bloom's Syndrome Foundation
Cancer Prevention and Research Institute of Texas	PP110171
University of Texas Anderson Cancer Center	P30CA016672, P30CA225520, P30CA076292
National Center for Complementary and Integrative Health	K23AT008442
Oklahoma Tobacco Settlement Endowment Trust	092-016-0002
ARC Centre of Excellence in Cognition and its Disorders

Keywords

Implementation
Latinas: low-SES
Latinos
Qualitative
Quitline
Smoking cessation

ASJC Scopus subject areas

Applied Psychology
Behavioral Neuroscience

Access to Document

10.1093/tbm/ibad007

Cite this

Shorey Fennell, B., Cottrell-Daniels, C., Hoover, D. S., Spears, C. A., Nguyen, N., Piñeiro, B., McNeill, L. H., Wetter, D. W., Vidrine, D. J., & Vidrine, J. I. (2023). The implementation of ask-advise-connect in a federally qualified health center: a mixed methods evaluation using the re-aim framework. Translational Behavioral Medicine, 13(8), 551-560. https://doi.org/10.1093/tbm/ibad007

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abstract = "Ask-Advise-Connect (AAC) efficiently links smokers in healthcare settings with evidence-based Quitline-delivered tobacco treatment through training clinic staff to systematically ask patients about smoking status, advise smokers to quit, and connect patients with state Quitlines using the electronic health record. This study utilized a mixed-methods approach, guided by the RE-AIM framework, to evaluate the implementation of AAC in a Federally Qualified Health Center (FQHC). AAC was implemented for 18 months at a FQHC serving primarily low-socioeconomic status (SES) Latinos and Latinas. Results are presented within the RE-AIM conceptual framework which includes dimensions of reach, effectiveness, adoption, implementation, and maintenance. Quantitative patient-level outcomes of reach, effectiveness, and Impact were calculated. Post-implementation, in-depth interviews were conducted with clinic leadership and staff (N = 9) to gather perceptions and inform future implementation efforts. During the implementation period, 12.0\% of GNHC patients who reported current smoking both agreed to have their information sent to the Quitline and were successfully contacted by the Quitline (Reach), 94.8\% of patients who spoke with the Quitline enrolled in treatment (Effectiveness), and 11.4\% of all identified smokers enrolled in Quitline treatment (Impact). In post-implementation interviews assessing RE-AIM dimensions, clinic staff and leadership identified facilitators and advantages of AAC and reported that AAC was easy to learn and implement, streamlined existing procedures, and had a positive impact on patients. Staff and leadership reported enthusiasm about AAC implementation and believed AAC fit well in the clinic. Staff were interested in AAC becoming the standard of care and made suggestions for future implementation. Clinic staff at a FQHC serving primarily low-SES Latinos and Latinas viewed the ACC implementation process positively. Findings have implications for streamlining clinical smoking cessation procedures and the potential to reduce tobacco-related disparities.",

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Shorey Fennell, B, Cottrell-Daniels, C, Hoover, DS, Spears, CA, Nguyen, N, Piñeiro, B, McNeill, LH, Wetter, DW, Vidrine, DJ & Vidrine, JI 2023, 'The implementation of ask-advise-connect in a federally qualified health center: a mixed methods evaluation using the re-aim framework', Translational Behavioral Medicine, vol. 13, no. 8, pp. 551-560. https://doi.org/10.1093/tbm/ibad007

TY - JOUR

T1 - The implementation of ask-advise-connect in a federally qualified health center

T2 - a mixed methods evaluation using the re-aim framework

AU - Shorey Fennell, Bethany

AU - Cottrell-Daniels, Cherell

AU - Hoover, Diana Stewart

AU - Spears, Claire A.

AU - Nguyen, Nga

AU - Piñeiro, Bárbara

AU - McNeill, Lorna H.

AU - Wetter, David W.

AU - Vidrine, Damon J.

AU - Vidrine, Jennifer I.

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AB - Ask-Advise-Connect (AAC) efficiently links smokers in healthcare settings with evidence-based Quitline-delivered tobacco treatment through training clinic staff to systematically ask patients about smoking status, advise smokers to quit, and connect patients with state Quitlines using the electronic health record. This study utilized a mixed-methods approach, guided by the RE-AIM framework, to evaluate the implementation of AAC in a Federally Qualified Health Center (FQHC). AAC was implemented for 18 months at a FQHC serving primarily low-socioeconomic status (SES) Latinos and Latinas. Results are presented within the RE-AIM conceptual framework which includes dimensions of reach, effectiveness, adoption, implementation, and maintenance. Quantitative patient-level outcomes of reach, effectiveness, and Impact were calculated. Post-implementation, in-depth interviews were conducted with clinic leadership and staff (N = 9) to gather perceptions and inform future implementation efforts. During the implementation period, 12.0% of GNHC patients who reported current smoking both agreed to have their information sent to the Quitline and were successfully contacted by the Quitline (Reach), 94.8% of patients who spoke with the Quitline enrolled in treatment (Effectiveness), and 11.4% of all identified smokers enrolled in Quitline treatment (Impact). In post-implementation interviews assessing RE-AIM dimensions, clinic staff and leadership identified facilitators and advantages of AAC and reported that AAC was easy to learn and implement, streamlined existing procedures, and had a positive impact on patients. Staff and leadership reported enthusiasm about AAC implementation and believed AAC fit well in the clinic. Staff were interested in AAC becoming the standard of care and made suggestions for future implementation. Clinic staff at a FQHC serving primarily low-SES Latinos and Latinas viewed the ACC implementation process positively. Findings have implications for streamlining clinical smoking cessation procedures and the potential to reduce tobacco-related disparities.

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KW - Latinas: low-SES

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The implementation of ask-advise-connect in a federally qualified health center: a mixed methods evaluation using the re-aim framework

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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