abstract: 'Lay Summary Ask-Advise-Connect (AAC) simplifies and streamlines the

  process of asking patients about their smoking status, advising smokers

  to quit, and connecting patients through the electronic health record

  with free, evidence-based tobacco cessation treatment offered by state

  Quitlines. This study is the first to evaluate perceptions of AAC among

  clinic leadership and staff. After an 18-month implementation of AAC at

  a clinic serving mostly low-income Latinos and Latinas, clinic staff

  (e.g., medical assistants) and leaders were interviewed. Respondents

  reported that AAC streamlined their efforts to get patients to quit

  smoking, was easy to carry out, and fit well into the clinic flow. Staff

  wanted to keep AAC as the standard of care and made suggestions to

  improve how AAC works. They reported positive feedback from patients. In

  addition, a similar proportion of smokers enrolled in Quitline treatment

  as in other AAC trials. Thus, AAC worked well for patients and clinic

  staff. Having AAC in other clinics could improve enrollment in

  evidence-based smoking cessation treatment, facilitate successful

  smoking cessation among low-income primary care patients, and reduce

  burden on healthcare providers.

  This study is the first to evaluate clinic staff and leadership

  perceptions of Ask-Advise-Connect (AAC), which seamlessly connects

  smokers in healthcare settings with evidence-based tobacco treatment

  using the EHR. Clinic staff and leadership reported enthusiasm for AAC

  implementation, as the procedure streamlined the clinic''s smoking

  cessation efforts, fit well into clinic flow, and was beneficial to

  patients.

  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.'
affiliation: 'Fennell, BS (Corresponding Author), H Lee Moffitt Canc Ctr \& Res Inst,
  Dept Hlth Outcomes \& Behav, Tampa, FL 33612 USA.

  Shorey Fennell, Bethany; Cottrell-Daniels, Cherell; Vidrine, Damon J.; Vidrine,
  Jennifer, I, H Lee Moffitt Canc Ctr \& Res Inst, Dept Hlth Outcomes \& Behav, Tampa,
  FL 33612 USA.

  Hoover, Diana Stewart, Hoover Editing, Asheville, NC USA.

  Spears, Claire A., Georgia State Univ, Sch Publ Hlth, Div Hlth Promot \& Behav,
  Atlanta, GA USA.

  Nguyen, Nga, Univ Texas MD Anderson Canc Ctr, Dept Biostat, Houston, TX USA.

  Pineiro, Barbara, Univ Autonoma Barcelona, Ctr Estudis Demograf, Catalonia 08193,
  Spain.

  McNeill, Lorna H., Univ Texas MD Anderson Canc Ctr, Dept Hlth Dispar Res, Houston,
  TX USA.

  Wetter, David W., Univ Utah, Huntsman Canc Inst, Ctr Hlth Outcomes \& Populat Equ,
  Dept Populat Hlth Sci, Salt Lake City, UT USA.'
author: Shorey Fennell, Bethany and Cottrell-Daniels, Cherell and Hoover, Diana Stewart
  and Spears, Claire A. and Nguyen, Nga and Pineiro, Barbara and McNeill, Lorna H.
  and Wetter, David W. and Vidrine, Damon J. and Vidrine I, Jennifer
author-email: Bethany.ShoreyFennell@moffitt.org
author_list:
- family: Shorey Fennell
  given: Bethany
- family: Cottrell-Daniels
  given: Cherell
- family: Hoover
  given: Diana Stewart
- family: Spears
  given: Claire A.
- family: Nguyen
  given: Nga
- family: Pineiro
  given: Barbara
- family: McNeill
  given: Lorna H.
- family: Wetter
  given: David W.
- family: Vidrine
  given: Damon J.
- family: Vidrine I
  given: Jennifer
da: '2023-09-28'
doi: 10.1093/tbm/ibad007
earlyaccessdate: MAR 2023
eissn: 1613-9860
files: []
issn: 1869-6716
journal: TRANSLATIONAL BEHAVIORAL MEDICINE
keywords: 'Implementation; Qualitative; Smoking cessation; Quitline; Latinos;

  Latinas; low-SES'
keywords-plus: 'SMOKING-CESSATION; CIGARETTE-SMOKING; UNITED-STATES; PRIMARY-CARE;

  TOBACCO; INTERVENTION; SMOKERS; IMPACT; DISPARITIES; QUITLINES'
language: English
month: AUG 11
number: '8'
number-of-cited-references: '56'
orcid-numbers: Shorey Fennell, Bethany/0000-0003-2188-6544
pages: 551-560
papis_id: 2c39f272764b307cfa51e9640e92a9f1
ref: Shoreyfennell2023implementationaskadv
times-cited: '0'
title: 'The implementation of ask-advise-connect in a federally qualified health center:
  a mixed methods evaluation using the re-aim framework'
type: article
unique-id: WOS:000961071600001
usage-count-last-180-days: '3'
usage-count-since-2013: '3'
volume: '13'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2023'