Health System Implementation of a Tobacco Quitline eReferralFunding Support from various partners include California Tobacco Control Program (CTCP: CG14–10611), Center for Disease Control, Health Resources and Services Administration (HRSA), University of California Office of the President's Center for Health Quality and Innovation, and National Center for Advancing Translational Sciences. Support for author E.A.H.M. was provided by grant number T32HP30037 from the Health Resources and Services Administration (HRSA) through the QSCERT-PC Program, and supported by the National Center for Advancing Translational Sciences, and National Institutes of Health, through grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
05 June 2019
02 August 2019
02 October 2019 (online)
Background Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on “real-world” implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden.
Objectives This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system.
Methods This is a prospective implementation study of a health system tobacco eReferral to a state quitline that was completed with an approach to minimize provider cognitive burden. Data are drawn from electronic health record data at University of California, Davis Health Systems (March 2013–February 2016).
Results Over 3 years, 16,083 encounters with smokers resulted in 1,137 eReferral orders (7.1%). Treatment reach was 1.6% for quitline services and 2.3% for outpatient group classes. While the group classes were offered to outpatient smokers, the eReferral order was included in an outpatient order set and eventually an automated inpatient discharge order set; no provider alerts were implemented. Referrals were sustained and doubled after inpatient order set implementation. Among all first time eReferral patients, 12.2% had a 6 to 12 month follow-up visit at which they were documented as nonsmoking.
Conclusion This study demonstrates a quitline eReferral order can be successfully implemented and sustained with minimal promotion, without provider alerts and in conjunction with group classes. Reach and effectiveness were similar to previously described literature.
Keywordsspecific condition: tobacco use cessation - electronic health record - implementation science - preventive medicine - adoption
Protection of Human and Animal Subjects
The Institutional Review Board of UCD determined this study was not human patients' research.
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