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

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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.