Smoking cessation for hospitalized smokers: An evaluation of the Ottawa Model

Interventions for hospitalized smokers can increase long-term smoking cessation rates. The Ottawa Model for Smoking Cessation (the Ottawa Model) is an application of the 5 A's approach to cessation, customized to the hospital setting. This study evaluated the impact of implementing the Ottawa Model in 9 hospitals in eastern Ontario. The RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was used to evaluate the intervention. Trained outreach facilitators assisted 9 hospitals to implement the Ottawa Model; program delivery was then monitored over a 1-year period using administrative data and data from a follow-up database. A before-and-after study was conducted to gauge the effect of the Ottawa Model program on cessation rates 6 months after hospitalization. Self-reports of smoking cessation were biochemically confirmed in a random sample of patients, and all cessation rates were corrected for potential misreporting. Sixty-nine percent of the expected number of smokers received the Ottawa Model intervention. Controlling for hospital, the confirmed 6-month continuous abstinence rate was higher after, than before, introduction of the Ottawa Model (29.4% vs. 18.3%; odds ratio = 1.71, 95% CI = 1.11-2.64; Z = 2.43; I-2 = 0%; p = .02). The intervention was more likely to accomplish counseling for smokers than delivery of medications or postdischarge follow-up. Attitudinal, managerial, and environmental challenges to program implementation were identified. Trained outreach facilitators successfully implemented the Ottawa Model in 9 hospitals leading to significantly higher long-term cessation rates. The public health implications of systematic cessation programs for hospitalized smokers are profound.