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J Gen Intern Med. 2012 Dec;27(12):1690-6. doi: 10.1007/s11606-012-2174-6. Epub 2012 Aug 4.

Implementation of an electronic health record-based care management system to improve tobacco treatment.

Author information

  • 1Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. gkruse@partners.org

Abstract

BACKGROUND:

Tobacco treatment is underused in primary care. We designed a Tobacco Care Management system to increase the delivery of treatment and reduce the burden on primary care providers (PCPs). A one-click functionality added to the electronic health record (EHR) allowed PCPs to refer smokers to a centralized tobacco treatment coordinator (TTC) who called smokers, provided brief counseling, connected them to ongoing treatment and gave feedback to PCPs.

OBJECTIVE:

To study the system's feasibility and acceptability among PCPs, and its utilization by smokers.

DESIGN:

Using a mixed methods design, we documented system utilization quantitatively from February 1, 2010 to July 31, 2011, and conducted two focus groups with PCPs in June 2011.

PARTICIPANTS:

Thirty-six PCPs and 2,894 smokers from two community health centers in Massachusetts.

MAIN MEASURES:

Quantitative: One-click referral utilization by PCPs, proportion of smokers referred and connected to treatment. Qualitative: PCPs' reasons for use, barriers to use, and experiences with feedback.

KEY RESULTS:

Twenty-nine PCPs (81 %) used the functionality more than once, generating 466 referrals for 15 % of known smokers seen during the study. The TTC reached 260 (56 %) of the referrals and connected 135 (29 %) to additional treatment. The director of one center sent PCPs monthly feedback about their utilization compared to peers. These PCPs referred a greater proportion of their known smokers (18 % vs. 9 %, p<0.0001) and reported that monthly feedback motivated referrals. PCPs attending focus groups (n=24) appreciated the system's simplicity, access to updated resources, and time-efficient way to address smoking, and wanted more feedback about cessation outcomes. They collectively supported the system's continuation.

CONCLUSIONS:

A novel EHR-based Tobacco Care Management system was adopted by PCPs, especially those receiving performance feedback, and connected one-third of referred smokers to treatment. The model has the potential to improve the delivery and outcomes of evidence-based tobacco treatment in primary care.

PMID:
22865018
[PubMed - indexed for MEDLINE]
PMCID:
PMC3509313
Free PMC Article

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