1. The Greater Cleveland Cancer Prevention Research Collaborating Center Sue Flocke, PhD Case Western Reserve University October 29, 2014 This presentation was supported by Cooperative Agreement Number 1U48DP001930 from the Centers for Disease Control and Prevention. The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

2. Prevention Research Center for Healthy Neighborhoods (PRCHN) Funded as part of national PRC network in 2009 Our Focus: Disadvantaged urban neighborhoods –Community nutrition and food access –Tobacco prevention & cessation –Supportive environments for healthy eating and active living –Place-based health surveillance 2 78 out of 202 census tracts in Cleveland have greater than 30% living in poverty and > 25% without HS diploma.

3. Priority for CPCRN Tobacco use is a significant burden Cleveland 31.5% Ohio22.4 US20.0

4. Specific Aims 1.Conduct a study to improve efficiency and effectiveness of tobacco cessation referrals. Implement and test closed loop E-referral to QuitLine. 2.Establish an evidence activation team and rapid PDSA cycles to inform and impact policy and practice. 3.Contribute to the overall impact and success of the national CPCRN initiatives through cross-center collaboration.

5. PRCHN-CPCRN Investigators & Partners MetroHealth Seeholzer Kaelber, IS Other IT and clinical staff 10 community clinics Tobacco Research Working Group PRC Flocke, PI Smith, Proj. Coord. Seeholzer, Co-I Trapl, Co-I Koroukian, Co-I National Jewish Health Quit Line provider Ohio Dept of Health Network of Community Advisors

6. Patient characteristics of adults who saw a MetroHealth provider for primary care in past 2 years

7. Ask Advise Connect (AAC) Approach very successful in safety-net settings. Systematic – EHR driven Engages medical assistant vs. clinician Facilitates documentation and referral to QuitLine Vidrine JI, Shete S, Li Y, et al. The ask-advise-connect approach for smokers in a safety net healthcare system: a group-randomized trial. Am J Prev Med. 2013;45(6):737–41. Vidrine JI, Shete S, Cao Y, et al. Ask-Advise-Connect A New Approach to Smoking Treatment Delivery in Health Care Settings. JAMA Intern Med. 2013;173(6):458–64.

9. Project Phases PhaseProducts Phase 1Establish & test closed loop e-Referral protocol Guide for establishing linkage Epic – NJH Revised protocol for AAC training Training manual for referral specialist Resource document for NE Ohio Phase 2Pilot test in 2 sites; Evaluate impact across 10 sites Manuscripts on outcomes - Implementation AAC - Quit Line data – appropriate referrals, enrollment - Patient report data – helpful, respectful Phase 3Develop tools and strategy for dissemination (statewide) Learning Collaborative materials

10. Proposed Cross-Center Projects Implement and test AAC and eReferral across multiple settings. –Randomize and test additional features –Best partners are those with Epic and strong working relationships with primary care networks Other areas of interest –Capacity building & use of existing data –Integrating farmers’ markets with FQHC systems – opportunity with the new Food Insecurity Nutrition Program grants from USDA and food assistance incentive programs. –Collaboration across HPV initiatives – systems level and population-based interventions.