New program helps hospital patients to kick the smoking habit

Christiana Care hospital patients who smoke have a new resource to help them kick the habit. Project Connect, a pilot program of the Heart and Vascular Service Line, links them with a state initiative that provides free counseling and eight weeks’ worth of tobacco-cessation medication.

“Project Connect is the first Christiana Care Health System coordinated effort to engage smokers in tobacco-cessation counseling after hospital discharge,” said Edward Goldenberg, M.D., FACC, director of preventive cardiology.

Dr. Goldenberg, who founded Million Hearts Delaware in 2012 as part of a nationwide endeavor to prevent 1 million heart attacks and strokes by 2017, saw an opportunity to optimize the health outcomes of these patients. The Million Hearts project already had focused on the “ABC” of heart health — aspirin, blood pressure and cholesterol. Now, the project would complete the acronym by targeting the final “S” — smoking, the leading preventable cause of death and disability.

“If you can get them to stop smoking, within 24 hours there are actual physiological changes going on,” he said. “Five years after quitting, they have the stroke risk of a nonsmoker, and after 15 years, their risk of heart disease returns to that of a nonsmoker.”

Each day, about 150 smokers are seen at Christiana Care hospitals.

Many patients in the hospital have received a wake-up call in the form of a heart attack or stroke and are motivated to change their behavior. The key was finding a way to engage them after they leave the hospital. During their stay, smokers receive nicotine patches when medically appropriate. But once they walk out the door, they’re on their own.

“Patients are forced to quit smoking while they are hospitalized, but without a support system on the outside, many return to the habit,” said Denise Taylor, MS, RD, project manager.

Studies show that if a smoker can get through two weeks of abstinence, he or she has a better chance of staying tobacco-free. Interventions that begin with a hospital stay and continue with supportive contact for at least one month after discharge increase the proportion of smokers who quit by 37 percent.

Project Connect is a collaboration of team members from cardiovascular prevention, information technology, nursing, pharmacy, the Value Institute and volunteer services. Because it uses volunteers and refers patients to the free Delaware Quitline program, costs are minimal, Taylor said.

Here’s how it works: Each day, patients admitted to the heart and vascular units are asked if they use tobacco products. Those who say yes receive a visit from a Project Connect volunteer, who engages the patient in a nonjudgmental, non-nagging discussion about quitting tobacco. To ensure the patients who want to stop smoking don’t relapse during the time it takes to get enrolled in the Delaware Quitline, Project Connect invests in a four-day supply of nicotine patches.

Patients who are ready to quit in the next 30 days and want to work with the Quitline are fax-referred, and the Quitline calls them within 72 hours after discharge.

Proactively contacting patients has been shown to increase the number of smokers enrolling in treatment thirteen-fold, Taylor said. Three days after discharge, a Christiana Care nurse phones the patient with a reminder. Program volunteers also check in with the patient after three months.

From mid-February, when Project Connect started, through May, 303 patients were visited by a trained volunteer. Of those, 128 were referred to the Delaware Quitline, and 49 subsequently enrolled in the service. Since the project’s inception, the monthly average number of referrals to the Delaware Quitline has increased from five to 40.

The initiative dovetails with a larger systemwide push to treat the whole patient as part of a move toward a value-based model of care.

“Project Connect represents a value-based approach by treating tobacco use as a chronic disease that is addressed in the hospital and managed through referral to free resources in the community,” she said.

Phase 2 of Project Connect will be a joint effort of the Heart and Vascular, Acute Medicine and Neurosciences service lines. Project Connect will have a dedicated tobacco treatment specialist who can provide a more intensive bedside visit and reach more patients, but will continue to use volunteers to support the service.