Evaluating EHR-Based Health System Modifications for the Chronic Care of Smoking

在美国，吸烟是癌症死亡的首要可预防原因。尽管它有着深厚的健康和 经济成本，吸烟治疗在医疗保健环境中很少提供，当提供时， 不够有效。为了解决这个问题，项目1将开发和评估更高效的电子健康 记录(EHR)方法，以识别吸烟者并使他们参与循证治疗。具体来说， 项目1将开发和测试新的电子病历增强功能和相关的医疗实践，这些实践包括 旨在有效地识别吸烟者并将他们招募到吸烟的长期护理治疗中(这将 在项目2-4中进行开发和评估)。电子健康记录的增强将包括：1)吸烟者识别 和文件辅助工具，2)“吸烟者登记处”(存储有关吸烟者的数据并促进 随着时间的推移跟踪他们的吸烟状态)，3)一键系统，将吸烟者推荐到慢性护理治疗 对于吸烟，4)闭环功能，向临床医生提供关于其结果的EHR反馈 转诊，以及5)传播资源，以告知吸烟者治疗选择并增加他们的 招募到治疗中。以电子健康记录为基础的强化和长期护理吸烟的效果 治疗将用多基线设计进行评估，涉及三个地区的18个初级保健诊所 威斯康星州的医疗保健系统；项目2-4的所有参与者将从这些诊所招募。在……里面 此外，项目1的子研究将使用混合方法研究策略(包括两份问卷 和定性访谈)，以确定有效实施以电子健康记录为基础的临床层面的障碍 吸烟者招募系统。这项高度创新的研究将评估一套综合的 EHR增强--再加上吸烟治疗的慢性护理方法--关于吸烟者识别， 以及吸烟治疗、转诊和参与。此外，这项研究还将探索影响 基于电子病历的增强措施在临床中的使用。综上所述，本研究将开发一套基于EHR的健康 系统增强，既增加了医疗保健系统对慢性护理治疗的采用，也增加了 吸烟者对这种治疗的参与度。

Smoking is the leading preventable cause of cancer mortality in the US. Despite its profound health and economic costs, smoking treatment is infrequently provided in healthcare settings, and when provided, it is not sufficiently effective. To address this, Project 1 will develop and evaluate more efficient electronic health record (EHR) methods to identify smokers and engage them in evidence-based treatment. Specifically, Project 1 will develop and test new EHR enhancements and associated healthcare practices that are designed to efficiently identify smokers and recruit them into a chronic care treatment for smoking (which will be developed and evaluated in Projects 2-4). The EHR enhancements will include: 1) smoker identification and documentation aids, 2) a "Smoker Registry" (which stores relevant data on smokers and facilitates tracking their smoking status over time), 3) a 1-click system to refer smokers to the chronic care treatment for smoking, 4) a closed-loop function to provide EHR feedback to clinicians on the outcomes of their referrals, and 5) communications resources to inform smokers of treatment options and to increase their recruitment into treatment. The effects of the EHR-based enhancements and the chronic care smoking treatment will be evaluated with a multiple baseline design involving 18 primary care clinics in three healthcare systems in Wisconsin; all participants for Projects 2-4 will be recruited from these clinics. In addition, a Project 1 Substudy will use a mixed-methods research strategy (comprising both questionnaires and qualitative interviews) to identify clinic-level obstacles to the effective implementation of the EHR-based smoker recruitment system. This highly innovative research will evaluate the impact of an integrated set of EHR enhancements—coupled with a chronic care approach to smoking treatment—on smoker identification, and smoking treatment referral and engagement. In addition, this research will explore factors that influence the use of EHR-based enhancements in clinics. In sum, this research will develop a set of EHR-based health system enhancements that increase both the adoption of chronic care treatment by healthcare systems and smokers' engagement in that treatment.