From: Overview of the consortium of hospitals advancing research on tobacco (chart)
Hospitalization medical record data | |
---|---|
1 | Length of stay (hours, calculated from admission and discharge date/time) |
2 | Height (cm or in) |
3 | Weight (kg or lbs) |
4 | Insurance (public, private, none) |
5 | Primary and secondary discharge diagnoses (ICD-9) |
6 | Diagnostic related groups |
7 | Procedure codes |
8 | Admission through emergency room (yes, no) |
9 | Hospital service at admission |
10 | Discharge plan (home, skilled nursing, rehab) |
Eligibility criteria measures | |
1 | Patient age (via medical record or patient report) |
2 | Did you smoke a cigarette (even one puff) in the past 30 days? (yes, no) |
3 | What is your plan about smoking after you leave the hospital? (I plan to quit when I leave the hospital, I plan to try to quit when I leave the hospital, I don’t know if I’m going to quit, I do not plan to quit) |
Baseline Patient Report | |
1 | Are you of Hispanic, Latino, or Spanish origin (yes, no) |
2 | What is your race? (standard NIH response options) |
3 | What is your sex? (male, female, other) |
4 | What is the highest level of education that you havecompleted? (< high school, high school, general equivalency exam, some college, 4 year college graduate or higher) |
5 | What is your marital status? (married/domestic partner, separated, divorced, widowed, never married) |
6 | In the past 30 days, on how many days did you smoke? (1 to 30) |
7 | On the days you smoked, how many cigarettes on average did you smoke? |
8 | Did you use any other tobacco product besides cigarettes in the past 30 days? |
9 | How confident are you that you will be able to quit/stay quit once you are discharged from the hospital (5 point scale from “not at all confident” to “very confident”) |
10 | Does anyone in your household smoke (other than you)? (yes/no/live alone) |