Designing for Sustainability: An Approach to Integrating Staff Role Changes and Electronic Health Record Functionality Within Safety-Net Clinics to Address Provision of Tobacco Cessation Care

Susan A. Flocke, Eileen Seeholzer, Steven A. Lewis, India J. Gill, Elvira Ordillas, Jeanmarie C. Rose, Elizabeth Albert, Thomas E. Love, David C. Kaelber

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalJoint Commission Journal on Quality and Patient Safety
DOIs
StateAccepted/In press - Jan 1 2019

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Safety-net Providers
Tobacco Use Cessation
Electronic Health Records
Odds Ratio
Confidence Intervals
Referral and Consultation
Primary Health Care
Smoking
Quality of Health Care
Tobacco Use
Guidelines

ASJC Scopus subject areas

  • Leadership and Management

Cite this

Designing for Sustainability : An Approach to Integrating Staff Role Changes and Electronic Health Record Functionality Within Safety-Net Clinics to Address Provision of Tobacco Cessation Care. / Flocke, Susan A.; Seeholzer, Eileen; Lewis, Steven A.; Gill, India J.; Ordillas, Elvira; Rose, Jeanmarie C.; Albert, Elizabeth; Love, Thomas E.; Kaelber, David C.

In: Joint Commission Journal on Quality and Patient Safety, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Designing for Sustainability: An Approach to Integrating Staff Role Changes and Electronic Health Record Functionality Within Safety-Net Clinics to Address Provision of Tobacco Cessation Care",
abstract = "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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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.

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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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