Comparative effectiveness of post-discharge strategies for hospitalized smokers: Study protocol for the Helping HAND 4 randomized controlled trial

Table 2 Operationalization of treatment components of the study interventions

Treatment component	eReferral to Quitline model	Personalized Tobacco Care Management model
Post-discharge outreach
Modality	Phone call from state QL	Automated phone call or text message from IVR vendor
Frequency	1 call initiated after discharge to offer QL services	7 calls made over 3 months after discharge (3 days; 2, 4, 6, 8, 10, 12 weeks)
Free counseling
Services offered	5-call QL protocol (for 3 months) if participant enrolls in QL services	Up to 7 calls (over 3 months)
When offered	At initial call from QL	On demand at each of 7 IVR calls
Provider	QL-based tobacco coach	Hospital-based tobacco coach
Free medication
Type	Nicotine replacement: patch ± gum ± lozenge (varies by state^a)	Nicotine replacement: patch, gum, lozenge, inhaler or combination
Duration of treatment	4–8 weeks (varies by state^b)	8 weeks
When provided	Mailed by QL after discharge if participant enrolls in QL services	Provided in hand at discharge
Care coordination	NA	Tobacco coach interfaces with PCP via EHR notes at start and end of 3-month treatment and as needed for medication prescriptions in between
EHR integration	Outbound: EHR referral link to QL; Inbound: varies by state^c	Tobacco Coach notes and medication prescriptions are in EHR
Patient choice	NA	Patient chooses mode of contact (IVR, text, email) & treatment (phone, text)

QL quitline, NJH National Jewish Health quitline, EHR electronic health record, IVR interactive voice response, PCP primary care provider, SmokefreeTXT free NCI text messaging program
^a NJH serving participants in Massachusetts, Pennsylvania, and Kentucky offers patch and gum or lozenge. IQH serving Tennessee participants offers only patch
^b Pennsylvania increased free NRT provision to 8 weeks in July 2019. Massachusetts increased free NRT provision to 8 weeks in October 2019. Tennessee increased free NRT provision to 8 weeks for women aged 14–49 years in January 2019
^c VUMC site: bidirectional eReferral (results of outreach attempt sent from quitline to EHR, displayed as a note from outside provider. MGH site: outbound eReferral only (inbound result of outreach sent by fax to referring provider but not put into EHR). UPMC site: outbound only (inbound result sent electronically to EHR but does not generate EHR note)

ISSN: 1745-6215