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
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
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DOI：
10.1016/j.jcjq.2019.09.003
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发表时间：
2019-12-01
影响因子：
2.3
通讯作者：
Kaelber, David C.
中科院分区：
文献类型：
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作者：
Flocke, Susan A.;Seeholzer, Eileen;Kaelber, David C.
背景：指南敦促初级保健做法定期提供戒烟护理，但提供戒烟建议和帮助的质量指标滞后。这项研究评估了在初级保健诊所改善戒烟护理绩效的基于系统的策略的实施。方法：电子健康记录(EHR)的变化使工作人员能够记录他们询问烟草使用情况、建议患者戒烟、主动将患者连接到QL咨询师，以及转介感兴趣的患者接到QL的电话。医务助理(MA)接受了使用电子健康记录新部分的培训，他们的作用扩大到包括提供简短的戒烟建议和启动QL转诊。结果：戒烟护理的效果显著增加，并在实施后6个月持续(50.9%对76.3%；优势比[OR]=3.04；95%可信区间[CI]=2.80-3.31)，提供建议(15.1%对92.7%；OR=69.3；95%CI=51.88-92.60)，评估戒烟准备(22.8%比76.6%；OR=10.80；95%CI=8.92-13.08)，接受QL转介(1.3%比21.7%；OR=20.31；95%CI=4.91-84.05)。结论：关键利益相关者参与提供了系统变化干预，其中包括EHR支持的MA在QL转诊中的角色扩展；这些变化大大增加了戒烟护理的提供。
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.