12-Month Evaluation of an EHR-Supported Staff Role Change for Provision of Tobacco Cessation Care in
Friday, August 14, 2020
Posted by: Natalia Gromov
Flocke SA, Seeholzer E,
Lewis SA, et al.
12-Month Evaluation of
an EHR-Supported Staff Role Change for Provision of Tobacco Cessation Care in 8
Primary Care Safety-Net Clinics.
[published online ahead of print, 2020 Jul 23]. J Gen Intern Med.
2020;10.1007/s11606-020-06030-7. doi:10.1007/s11606-020-06030-7
Significance: Guidelines
urge primary care practices to routinely provide tobacco cessation care (i.e.,
assess tobacco use, provide brief cessation advice, and refer to cessation
support). This study evaluates the impact of a systems-based strategy to
provide tobacco cessation care in eight primary care clinics serving low-income
patients.
Methods: A
non-randomized stepped wedge study design was used to implement an intervention
consisting of (1) changes to the electronic health record (EHR) referral
functionality and (2) expansion of staff roles to provide brief advice to quit;
assess readiness to quit; offer a referral to tobacco cessation counseling; and
sign the referral order. Outcomes assessed from the EHR include performance of
tobacco cessation care tasks, referral contact, and enrollment rates for the
quitline (QL) and in-house Freedom from Smoking (FFS) program. Generalized
estimating equations (GEE) methods were used to compute odds ratios contrasting
the pre-implementation vs. 1-, 3-, 6-, and 12-month post-implementation
periods.
Results: Of
the 176,061 visits, 26.1% were by identified tobacco users. All indicators
significantly increased at each time period evaluated post-implementation. In
comparison with the pre-intervention period, assessing smoking status (26.6%
vs. 55.7%; OR = 3.7, CI = 3.6-3.9), providing advice (44.8% vs. 88.7%; OR =
7.8, CI = 6.6-9.1), assessing readiness to quit (15.8% vs. 55.0%; OR = 6.2, CI
= 5.4-7.0), and acceptance of a referral to tobacco cessation counseling (0.5%
vs. 30.9%; OR = 81.0, CI = 11.4-575.8) remained significantly higher 12 months
post-intervention. For the QL and FFS, respectively, there were 1223 and 532
referrals; 324 (31.1%) and 103 (24.7%) were contacted; 241 (74.4%) and 72
(69.6%) enrolled; and 195 (80.9%) and 14 (19.4%) received at least one
counseling session.
Conclusions: This
system change intervention that includes an EHR-supported role expansion
substantially increased the provision of tobacco cessation care and
improvements were sustained beyond 1 year. This approach has the potential to
greatly increase the number of individuals referred for tobacco cessation
counseling.
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