CWRU receives $2 million for smoking cessation research

Patient-Centered Outcomes Research Institute research funding award goes to investigating a more effective approach to get patients to stop smoking

Susan Flocke
Susan Flocke

A Case Western Reserve University School of Medicine team received $2 million from the Patient-Centered Outcomes Research Institute (PCORI) to study a combination approach to help patients, particularly those who are socially and economically disadvantaged, stop smoking. The project involves partnership with faculty and staff at MetroHealth Medical Center, as well as the Ohio Department of Health and National Jewish Health, the Quitline providers for Ohio.

The study team, led by Susan Flocke, will determine whether pairing the Teachable Moment Communication Process (TMCP) with the Ask-Advise-Connect (AAC) strategy will bolster smoking cessation outcomes.

The AAC approach focuses on a systems-based strategy for routinely identifying the smoking status of patients, providing brief advice and offering a referral to the Quitline, a hotline staffed by professionals trained in smoking cessation counseling.

This study will implement changes in the electronic health record to allow an electronic referral so that the Quitline proactively contacts patients who want smoking cessation assistance. TMCP, on the other hand, uses a communication strategy developed by Flocke’s team that incorporates the patient’s concerns into a clinician partnership-oriented discussion about stopping tobacco use.

The problem with AAC alone is that many patients referred to the Quitline are not ready to stop smoking, but they may feel obligated to accept the referral to the hotline from their primary care team. In prior studies, Quitline counselors successfully contacted less than 50 percent of patients who agreed to be referred, even after five call attempts. However, among those who are contacted, enrollment and engagement in counseling services are good and have a positive effect on cessation attempts.

By combining TMCP with AAC, the goal is to increase the numbers of patients referred to Quitline who are truly committed to smoking cessation and therefore more likely to enroll and benefit from tailored counseling. Investigators will pay particular attention to improving how smoking cessation advice and assistance are delivered to socially and economically disadvantaged patients.

The Case Western Reserve research team will conduct a randomized trial of the TMCP and AAC combo in eight clinics serving more than 25,000 patients who smoke. Data will be collected through patient surveys, electronic health records, and Quitline participation. Additionally, the study will involve in-depth interviews with subgroups of patients to learn ways to improve their referral to the Quitline.

“Research has shown that economically and socially disadvantaged individuals are more likely to smoke and less likely to use smoking cessation services,” said Flocke, associate professor in the Department of Family Medicine & Community Health and associate director of the Prevention Research Center for Health Neighborhoods. “With our research, we plan to systematically create linkages between primary care clinics and community resources to increase smoking cessation services to those people who are least likely to access them.”

“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill an important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options,” said PCORI executive director Joe Selby. “We look forward to following the study’s progress and working with Case Western Reserve University School of Medicine to share the results.”

Flocke’s study was selected for PCORI funding through a highly competitive review process in which patients, clinicians and other stakeholders joined clinical scientists to evaluate the proposals. Applications were assessed for scientific merit, how well they will engage patients and other stakeholders, and their methodological rigor among other criteria.

The award to Flocke has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.

PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit