A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results

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 hospitali...

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Autores principales: Bernstein, Steven L., Weiss, June, DeWitt, Michelle, Tetrault, Jeanette M., Hsiao, Allen L., Dziura, James, Sussman, Scott, Miller, Ted, Carpenter, Kelly, O’Connor, Patrick, Toll, Benjamin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343239/
https://www.ncbi.nlm.nih.gov/pubmed/30670043
http://dx.doi.org/10.1186/s13012-019-0856-8
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author Bernstein, Steven L.
Weiss, June
DeWitt, Michelle
Tetrault, Jeanette M.
Hsiao, Allen L.
Dziura, James
Sussman, Scott
Miller, Ted
Carpenter, Kelly
O’Connor, Patrick
Toll, Benjamin
author_facet Bernstein, Steven L.
Weiss, June
DeWitt, Michelle
Tetrault, Jeanette M.
Hsiao, Allen L.
Dziura, James
Sussman, Scott
Miller, Ted
Carpenter, Kelly
O’Connor, Patrick
Toll, Benjamin
author_sort Bernstein, Steven L.
collection PubMed
description 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
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spelling pubmed-63432392019-01-24 A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results Bernstein, Steven L. Weiss, June DeWitt, Michelle Tetrault, Jeanette M. Hsiao, Allen L. Dziura, James Sussman, Scott Miller, Ted Carpenter, Kelly O’Connor, Patrick Toll, Benjamin Implement Sci Research 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 BioMed Central 2019-01-22 /pmc/articles/PMC6343239/ /pubmed/30670043 http://dx.doi.org/10.1186/s13012-019-0856-8 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Bernstein, Steven L.
Weiss, June
DeWitt, Michelle
Tetrault, Jeanette M.
Hsiao, Allen L.
Dziura, James
Sussman, Scott
Miller, Ted
Carpenter, Kelly
O’Connor, Patrick
Toll, Benjamin
A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results
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 Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343239/
https://www.ncbi.nlm.nih.gov/pubmed/30670043
http://dx.doi.org/10.1186/s13012-019-0856-8
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