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NAQC Newsroom: Research

An Electronic Health Record-based Interoperable eReferral System to Enhance Smoking Quitline Treatme

Thursday, May 16, 2019  
Posted by: Natalia Gromov

Fiore M, Adsit R, Zehner M, McCarthy D, Lundsten S, Hartlaub P, Mahr T, Gorrilla A, Skora A, Baker T.
An Electronic Health Record-based Interoperable eReferral System to Enhance Smoking Quitline Treatment in Primary Care.
J Am Med Inform Assoc. 2019 May 15. pii: ocz044. doi: 10.1093/jamia/ocz044. [Epub ahead of print]

The study sought to determine whether interoperable, electronic health record–based referral (eReferral) produces higher rates of referral and connection to a state tobacco quitline than does fax-based referral, thus addressing low rates of smoking treatment delivery in health care. Twenty-three primary care clinics from 2 healthcare systems (A and B) in Wisconsin were randomized, unblinded, over 2016-2017, to 2 smoking treatment referral methods: paper-based fax-to-quit (system A ¼6, system B ¼ 6) or electronic (eReferral; system A ¼ 5, system B ¼ 6). Both methods referred adult patients who smoked to the Wisconsin Tobacco Quitline. A total of 14 636 smokers were seen in the 2 systems (system A: 54.5% women, mean age 48.2 years; system B: 53.8% women, mean age 50.2 years). Clinics with eReferral, vs fax-to-quit, referred a higher percentage of adult smokers to the quitline: system A clinic referral rate ¼ 17.9% (95% confidence interval [CI], 17.2%-18.5%) vs 3.8% (95% CI, 3.5%-4.2%) (P<.001); system B clinic referral rate ¼ 18.9% (95% CI, 18.3%-19.6%) vs 5.2% (95% CI, 4.9%-5.6%) (P<.001). Average rates of quitline connection were higher in eReferral than F2Q clinics: system A¼5.4% (95% CI, 5.0%-5.8%) vs 1.3% (95% CI, 1.1%-1.5%) (P<.001); system B¼5.3% (95% CI, 5.0%-5.7%) vs 2.0% (95% CI, 1.8%-2.2%) (P<.001). Electronic health record–based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates 3-4 times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals. eReferral may help address the challenge of providing smokers with treatment for tobacco use during busy primary care visits.

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