12-Month Evaluation of an EHR-Supported Staff Role Change for Provision of Tobacco Cessation Care in 8 Primary Care Safety-Net Clinics
12-Month Evaluation of an EHR-Supported Staff Role Change for Provision of Tobacco Cessation Care in 8 Primary Care Safety-Net Clinics
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DOI：
10.1007/s11606-020-06030-7
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发表时间：
2020-07-23
影响因子：
5.7
通讯作者：
Kaelber, David
中科院分区：
文献类型：
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作者：
Flocke, Susan A.;Seeholzer, Eileen;Kaelber, David
重要性指南敦促初级保健做法定期提供戒烟护理(即评估烟草使用情况，提供简短的戒烟建议，并提及戒烟支持)。这项研究评估了在为低收入患者提供服务的八家初级保健诊所提供戒烟护理的系统战略的影响。方法采用非随机化的阶梯式研究设计，实施包括(1)改变电子健康记录(EHR)转诊功能和(2)扩展工作人员角色以提供简短的戒烟建议、评估戒烟准备情况、提供转介至戒烟咨询和签署转介命令的干预措施。从EHR评估的结果包括戒烟护理任务的执行情况、转介接触者以及戒烟热线(QL)和内部戒烟自由(FFS)计划的注册率。使用广义估计方程(GEE)方法计算实施前与实施后1、3、6和12个月期间的优势比。结果在176,061次访问中，26.1%是由已识别的烟草使用者进行的。在实施后评估的每个时间段，所有指标均显着增加。与干预前相比，评估吸烟状况(26.6%比55.7%；OR=3.7，CI=3.6-3.9)，提供建议(44.8%比88.7%；OR=7.8，CI=6.6-9.1)，评估戒烟准备(15.8%比55.0%；OR=6.2，CI=5.4-7.0)，接受转介戒烟咨询(0.5%比30.9%；OR=81.0，CI=11.4~575.8)在干预后12个月仍显著高于干预前。在QL和FFS方面，分别有1223和532人被转介；324人(31.1%)和103人(24.7%)被联系；241人(74.4%)和72人(69.6%)被录用；195人(80.9%)和14人(19.4%)接受了至少一次咨询。结论包括EHR支持的角色扩展在内的这一系统变化干预显著增加了戒烟护理的提供，并且改善持续了1年以上。这种方法有可能极大地增加接受戒烟咨询的个人数量。
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.