A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results
Abstract Background Smokers usually abstain from tobacco while hospitalized but relapse after discharge. Inpatient interventions may encourage sustained quitting. We previously demonstrated that a decision support tool embedded in an electronic health record (EHR) improved physicians’ treatment of h...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13012-019-0856-8 |
| _version_ | 1819163788883001344 |
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| author | Steven L. Bernstein June Weiss Michelle DeWitt Jeanette M. Tetrault Allen L. Hsiao James Dziura Scott Sussman Ted Miller Kelly Carpenter Patrick O’Connor Benjamin Toll |
| author_facet | Steven L. Bernstein June Weiss Michelle DeWitt Jeanette M. Tetrault Allen L. Hsiao James Dziura Scott Sussman Ted Miller Kelly Carpenter Patrick O’Connor Benjamin Toll |
| author_sort | Steven L. Bernstein |
| collection | DOAJ |
| description | Abstract Background Smokers usually abstain from tobacco while hospitalized but relapse after discharge. Inpatient interventions may encourage sustained quitting. We previously demonstrated that a decision support tool embedded in an electronic health record (EHR) improved physicians’ treatment of hospitalized smokers. This report describes the effect on quit rates of this decision support tool and order set for hospitalized smokers. Methods In a single hospital system, 254 physicians were randomized 1:1 to receive a decision support tool and order set, embedded in the EHR. When an adult patient was admitted to a medical service, an electronic alert appeared if current smoking was recorded in the EHR. For physicians receiving the intervention, the alert linked to an order set for tobacco treatment medications and electronic referral to the state tobacco quitline. Additionally, “Tobacco Use Disorder” was added to the patient’s problem list, and a secure message was sent to the patient’s primary care provider (PCP). In the control arm, no alert appeared. Patients were contacted by phone at 1, 6, and 12 months; those reporting tobacco abstinence at 12 months were asked to return to measure exhaled carbon monoxide. Generalized estimating equations were used to model the data. Results From 2013 to 2016, the alert fired for 10,939 patients (5391 intervention, 5548 control). Compared to control physicians, intervention physicians were more likely to order tobacco treatment medication, populate the problem list with tobacco use disorder, refer to the quitline, and notify the patient’s PCP. In a subset of 1044 patients recruited for intensive follow-up, one-year quit rates for intervention and control patients were, respectively, 11.5% and 11.6%, (p = 0.94), after controlling for age, sex, race, ethnicity, and insurance. Similarly, there were no differences in 1- and 6-month quit rates. Conclusions Although we were able to improve processes of care, long-term tobacco quit rates were unchanged. This likely reflects, in part, the need for sustained quitting interventions, and higher-than-expected quit rates in controls. Future enhancements should improve prescription of medications for smoking cessation at discharge, engagement of primary care providers, and perhaps direct engagement of patients in a more longitudinal approach. Trial registration ClinicalTrials.gov, NCT01691105. Registered on September 12, 2012 |
| first_indexed | 2024-12-22T17:49:42Z |
| format | Article |
| id | doaj.art-bcd08ac72b394cc0aff60a3eded620a6 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-22T17:49:42Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-bcd08ac72b394cc0aff60a3eded620a62022-12-21T18:18:13ZengBMCImplementation Science1748-59082019-01-0114111110.1186/s13012-019-0856-8A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical resultsSteven L. Bernstein0June Weiss1Michelle DeWitt2Jeanette M. Tetrault3Allen L. Hsiao4James Dziura5Scott Sussman6Ted Miller7Kelly Carpenter8Patrick O’Connor9Benjamin Toll10Department of Emergency Medicine, Yale School of MedicineDepartment of Emergency Medicine, Yale School of MedicineYale-New Haven HospitalDepartment of Medicine, Yale School of MedicineDepartment of Emergency Medicine, Yale School of MedicineDepartment of Emergency Medicine, Yale School of MedicineDepartment of Medicine, Yale School of MedicinePacific Institute for Research and EvaluationOptum Center for Wellbeing Research (formerly Alere Wellbeing)Department of Medicine, Yale School of MedicineDepartment of Psychiatry, Yale School of MedicineAbstract Background Smokers usually abstain from tobacco while hospitalized but relapse after discharge. Inpatient interventions may encourage sustained quitting. We previously demonstrated that a decision support tool embedded in an electronic health record (EHR) improved physicians’ treatment of hospitalized smokers. This report describes the effect on quit rates of this decision support tool and order set for hospitalized smokers. Methods In a single hospital system, 254 physicians were randomized 1:1 to receive a decision support tool and order set, embedded in the EHR. When an adult patient was admitted to a medical service, an electronic alert appeared if current smoking was recorded in the EHR. For physicians receiving the intervention, the alert linked to an order set for tobacco treatment medications and electronic referral to the state tobacco quitline. Additionally, “Tobacco Use Disorder” was added to the patient’s problem list, and a secure message was sent to the patient’s primary care provider (PCP). In the control arm, no alert appeared. Patients were contacted by phone at 1, 6, and 12 months; those reporting tobacco abstinence at 12 months were asked to return to measure exhaled carbon monoxide. Generalized estimating equations were used to model the data. Results From 2013 to 2016, the alert fired for 10,939 patients (5391 intervention, 5548 control). Compared to control physicians, intervention physicians were more likely to order tobacco treatment medication, populate the problem list with tobacco use disorder, refer to the quitline, and notify the patient’s PCP. In a subset of 1044 patients recruited for intensive follow-up, one-year quit rates for intervention and control patients were, respectively, 11.5% and 11.6%, (p = 0.94), after controlling for age, sex, race, ethnicity, and insurance. Similarly, there were no differences in 1- and 6-month quit rates. Conclusions Although we were able to improve processes of care, long-term tobacco quit rates were unchanged. This likely reflects, in part, the need for sustained quitting interventions, and higher-than-expected quit rates in controls. Future enhancements should improve prescription of medications for smoking cessation at discharge, engagement of primary care providers, and perhaps direct engagement of patients in a more longitudinal approach. Trial registration ClinicalTrials.gov, NCT01691105. Registered on September 12, 2012http://link.springer.com/article/10.1186/s13012-019-0856-8Smoking cessationTobacco dependence treatmentDecision supportElectronic health records |
| spellingShingle | Steven L. Bernstein June Weiss Michelle DeWitt Jeanette M. Tetrault Allen L. Hsiao James Dziura Scott Sussman Ted Miller Kelly Carpenter Patrick O’Connor Benjamin Toll A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results Implementation Science Smoking cessation Tobacco dependence treatment Decision support Electronic health records |
| title | A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results |
| title_full | A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results |
| title_fullStr | A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results |
| title_full_unstemmed | A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results |
| title_short | A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results |
| title_sort | randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record clinical results |
| topic | Smoking cessation Tobacco dependence treatment Decision support Electronic health records |
| url | http://link.springer.com/article/10.1186/s13012-019-0856-8 |
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