TY - JOUR
KW - Adult
KW - Aged
KW - Directive Counseling
KW - Female
KW - Humans
KW - Male
KW - Massachusetts/epidemiology
KW - Medical Records Systems, Computerized
KW - Middle Aged
KW - Primary Health Care
KW - Smoking/drug therapy/epidemiology
KW - Tobacco Use Cessation/statistics & numerical data
AU - J. A. Linder
AU - N. A. Rigotti
AU - L. I. Schneider
AU - J. H. Kelley
AU - P. Brawarsky
AU - J. S. Haas
A1 - 
AB - BACKGROUND: To improve the documentation and treatment of tobacco use in primary care, we developed and implemented a 3-part electronic health record enhancement: (1)smoking status icons, (2) tobacco treatment reminders, and (3) a Tobacco Smart Form that facilitated the ordering of medication and fax and e-mail counseling referrals. METHODS: We performed a cluster-randomized controlled trial of the enhancement in 26 primary care practices between December 19, 2006, and September 30, 2007. The primary outcome was the proportion of documented smokers who made contact with a smoking cessation counselor. Secondary outcomes included coded smoking status documentation and medication prescribing. RESULTS: During the 9-month study period, 132 630 patients made 315 962 visits to study practices. Coded documentation of smoking status increased from 37% of patients to 54% (+17%) in intervention practices and from 35% of patients to 46% (+11%) in control practices (P < .001 for the difference in differences). Among the 9589 patients who were documented smokers at the start of the study, more patients in the intervention practices were recorded as nonsmokers by the end of the study (5.3% vs 1.9% in control practices; P < .001). Among 12 207 documented smokers, more patients in the intervention practices made contact with a cessation counselor (3.9% vs 0.3% in control practices; P < .001). Smokers in the intervention practices were no more likely to be prescribed smoking cessation medication (2% vs 2% in control practices; P = .40). CONCLUSION: This electronic health record-based intervention improved smoking status documentation and increased counseling assistance to smokers but not the prescription of cessation medication.
BT - Archives of Internal Medicine
C5 - HIT & Telehealth
CP - 8
CY - United States
DO - 10.1001/archinternmed.2009.53
IS - 8
JF - Archives of Internal Medicine
N2 - BACKGROUND: To improve the documentation and treatment of tobacco use in primary care, we developed and implemented a 3-part electronic health record enhancement: (1)smoking status icons, (2) tobacco treatment reminders, and (3) a Tobacco Smart Form that facilitated the ordering of medication and fax and e-mail counseling referrals. METHODS: We performed a cluster-randomized controlled trial of the enhancement in 26 primary care practices between December 19, 2006, and September 30, 2007. The primary outcome was the proportion of documented smokers who made contact with a smoking cessation counselor. Secondary outcomes included coded smoking status documentation and medication prescribing. RESULTS: During the 9-month study period, 132 630 patients made 315 962 visits to study practices. Coded documentation of smoking status increased from 37% of patients to 54% (+17%) in intervention practices and from 35% of patients to 46% (+11%) in control practices (P < .001 for the difference in differences). Among the 9589 patients who were documented smokers at the start of the study, more patients in the intervention practices were recorded as nonsmokers by the end of the study (5.3% vs 1.9% in control practices; P < .001). Among 12 207 documented smokers, more patients in the intervention practices made contact with a cessation counselor (3.9% vs 0.3% in control practices; P < .001). Smokers in the intervention practices were no more likely to be prescribed smoking cessation medication (2% vs 2% in control practices; P = .40). CONCLUSION: This electronic health record-based intervention improved smoking status documentation and increased counseling assistance to smokers but not the prescription of cessation medication.
PP - United States
PY - 2009
SN - 1538-3679; 0003-9926
SP - 781
EP - 787
EP - 
T1 - An electronic health record-based intervention to improve tobacco treatment in primary care: a cluster-randomized controlled trial
T2 - Archives of Internal Medicine
TI - An electronic health record-based intervention to improve tobacco treatment in primary care: a cluster-randomized controlled trial
U1 - HIT & Telehealth
U2 - 19398690
U3 - 10.1001/archinternmed.2009.53
VL - 169
VO - 1538-3679; 0003-9926
Y1 - 2009
ER -