Closed-Loop Electronic Referral From Primary Care Clinics to a State Tobacco Cessation Quitline: Effects Using Real-World Implementation Training.
Closed-Loop Electronic Referral From Primary Care Clinics to a State Tobacco Cessation Quitline: Effects Using Real-World Implementation Training.
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DOI：
10.1016/j.amepre.2019.12.026
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发表时间：
2021-03
影响因子：
5.5
通讯作者：
Fiore MC
中科院分区：
文献类型：
--
作者：
Baker TB;Berg KM;Adsit RT;Skora AD;Swedlund MP;Zehner ME;McCarthy DE;Glasgow RE;Fiore MC
吸烟的患者在医疗保健访问期间很少与烟草使用治疗有关。电子健康记录的增强可能会增加初级保健环境中的此类转诊。本项目使用范围、有效性、采用、实施和维护框架来评估以外部有效方式（由医疗保健系统执行）实施的医疗保健系统变更。医疗保健系统使用其标准的基于计算机的培训方法，在30家以前使用传真退出线转诊的初级保健诊所中实施电子健康记录和诊所工作流程变更。电子健康记录数据记录了实施前4个月和实施后8个月（2017年5月至12月）的戒烟准备评估率和戒烟热线转诊率。从2018年10月到2019年6月的数据分析也反映了干预的范围，采用和维护。覆盖面和有效性：从电子转诊实施前到实施后，在吸烟的成年患者中，戒烟准备程度的评估从24.8%增加到24.8%。（2，126/8，569）增加到93.2%（11，163/11，977），戒烟热线转介从1.7%（143/8，569）增加到11.3%（1，351/11，977），3.6%与实施后戒烟热线有关。覆盖范围的代表性：女性、非裔美国人和医疗补助患者的电子转诊率特别高。采用：52.6%的工作人员谁室友至少有一个吸烟的病人提到戒烟热线。维持：电子转诊率在8个月内下降了约60%，但仍高于实施前的比率。基于电子健康记录的电子转诊系统的实际实施显著提高了初级保健患者的戒烟准备评估和戒烟转诊率。未来的研究应重点关注能够更一致地实施和更好地维护电子推荐的实施方法。
Patients who use tobacco are too rarely connected with tobacco use treatment during healthcare visits. Electronic health record enhancements may increase such referrals in primary care settings. This project used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess implementation of a healthcare system change carried out in an externally valid manner (executed by the healthcare system). The healthcare system used their standard, computer-based training approach to implement the electronic health record and clinic workflow changes for eReferral in 30 primary care clinics that previously used faxed quitline referral. Electronic health record data captured rates of assessment of readiness to quit, and quitline referral 4 months pre- and 8 months (May–December 2017) post-implementation. Data, analyzed from October 2018 to June 2019, also reflected intervention reach, adoption, and maintenance. Reach and effectiveness: From pre-implementation to post-implementation for eReferral, among adult patients who smoked, assessment of readiness to quit increased from 24.8% (2,126/8,569) to 93.2% (11,163/11,977), and quitline referrals increased from 1.7% (143/8,569) to 11.3% (1,351/11,977) and 3.6% were connected with the quitline post-implementation. Representativeness of reach: eReferral rates were especially high for women, African Americans, and Medicaid patients. Adoption: 52.6% of staff who roomed at least one patient who smoked referred to the quitline. Maintenance: eReferral rates fell by approximately 60% over 8 months but remained higher than pre-implementation rates. Real-world implementation of an electronic health record–based, eReferral system markedly increased readiness to quit assessment and quitline referral rates in primary care patients. Future research should focus on implementation methods that produce more consistent implementation and better maintenance of eReferral.
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影响因子：
3.6
作者：
Adsit, Robert T.;Fox, Bradley M.;Fiore, Michael C.
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