TY - JOUR
T1 - Designing for Sustainability
T2 - An Approach to Integrating Staff Role Changes and Electronic Health Record Functionality Within Safety-Net Clinics to Address Provision of Tobacco Cessation Care
AU - Flocke, Susan A.
AU - Seeholzer, Eileen
AU - Lewis, Steven A.
AU - Gill, India J.
AU - Ordillas, Elvira
AU - Rose, Jeanmarie C.
AU - Albert, Elizabeth
AU - Love, Thomas E.
AU - Kaelber, David C.
N1 - Funding Information:
Research reported in this manuscript was funded through a Patient-Centered Outcomes Research Institute Ⓡ Award (IHS-1503-29879). The statements presented in this work are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute Ⓡ , its Board of Governors, or its Methodology Committee. The authors wish to thank Georgene Bosich, RN; Jay Koren, RN; and Versie Owens, MPA, who contributed to making this project possible.
Publisher Copyright:
© 2019 The Joint Commission
PY - 2019/12
Y1 - 2019/12
N2 - Background: Guidelines urge primary care practices to routinely provide tobacco cessation care, but quality indicators for the provision of advice and assistance to quit smoking lag. This study evaluated the implementation of a systems-based strategy to improve performance of tobacco cessation care in primary care clinics. Methods: Changes to the electronic health record (EHR) facilitated staff to document when they ask about tobacco use, advise the patient to quit, offer to connect the patient to a quitline (QL) counselor, and refer interested patients to receive a call from a QL. Medical assistants (MAs) were trained to use the new sections of the EHR, and their roles were expanded to include the provision of brief cessation advice and activation of the QL referral. Primary outcomes were change in tobacco cessation processes preimplementation vs. one, three, and six months postimplementation of the strategy. Results: The increase in performance of tobacco cessation care was significant and sustained at six months postimplementation for assessing smoking status (50.9% vs. 76.3%; odds ratio [OR] = 3.04; 95% confidence interval [CI] = 2.80–3.31), providing advice (15.1% vs. 92.7%; OR = 69.3; 95% CI = 51.88–92.60), assessing readiness to quit (22.8% vs. 76.6%; OR = 10.80; 95% CI = 8.92–13.08), and accepting a referral to the QL (1.3% vs. 21.7%; OR = 20.31; 95% CI = 4.91–84.05). Conclusion: Key stakeholder engagement informed a system change intervention that includes an EHR–supported role expansion of MAs for QL referrals; these changes substantially increased the provision of tobacco cessation care.
AB - Background: Guidelines urge primary care practices to routinely provide tobacco cessation care, but quality indicators for the provision of advice and assistance to quit smoking lag. This study evaluated the implementation of a systems-based strategy to improve performance of tobacco cessation care in primary care clinics. Methods: Changes to the electronic health record (EHR) facilitated staff to document when they ask about tobacco use, advise the patient to quit, offer to connect the patient to a quitline (QL) counselor, and refer interested patients to receive a call from a QL. Medical assistants (MAs) were trained to use the new sections of the EHR, and their roles were expanded to include the provision of brief cessation advice and activation of the QL referral. Primary outcomes were change in tobacco cessation processes preimplementation vs. one, three, and six months postimplementation of the strategy. Results: The increase in performance of tobacco cessation care was significant and sustained at six months postimplementation for assessing smoking status (50.9% vs. 76.3%; odds ratio [OR] = 3.04; 95% confidence interval [CI] = 2.80–3.31), providing advice (15.1% vs. 92.7%; OR = 69.3; 95% CI = 51.88–92.60), assessing readiness to quit (22.8% vs. 76.6%; OR = 10.80; 95% CI = 8.92–13.08), and accepting a referral to the QL (1.3% vs. 21.7%; OR = 20.31; 95% CI = 4.91–84.05). Conclusion: Key stakeholder engagement informed a system change intervention that includes an EHR–supported role expansion of MAs for QL referrals; these changes substantially increased the provision of tobacco cessation care.
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U2 - 10.1016/j.jcjq.2019.09.003
DO - 10.1016/j.jcjq.2019.09.003
M3 - Article
C2 - 31648946
AN - SCOPUS:85073818157
SN - 1553-7250
VL - 45
SP - 798
EP - 807
JO - Joint Commission Journal on Quality and Patient Safety
JF - Joint Commission Journal on Quality and Patient Safety
IS - 12
ER -