Provider feedback to improve 5A's tobacco cessation in primary care: a cluster randomized clinical trial

Nicotine Tob Res. 2007 Mar;9(3):341-9. doi: 10.1080/14622200701188828.


The electronic health record (EHR) may be an effective tool to help clinicians address tobacco use more consistently. To evaluate the impact of EHR-generated practice feedback on rates of referral to a state-level tobacco quitline, we conducted a cluster randomized clinical trial (feedback versus no feedback) within 19 primary care clinics in Oregon. Intervention clinics received provider-specific monthly feedback reports generated from EHR data. The reports rated provider performance in asking, advising, assessing, and assisting with tobacco cessation compared with a clinic average and an achievable benchmark of care. During 12 months of follow-up, EHR-documented rates of advising, assessing, and assisting were significantly improved in the intervention clinics compared with the control clinics (p<.001). A higher case-mix index and presence of a clinic champion were associated with higher rates of referral to a state-level quitline. EHR-generated provider feedback improved documentation of assistance with tobacco cessation. Connecting physician offices to a state-level quitline was feasible and well accepted.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Counseling / statistics & numerical data
  • Family Practice / organization & administration
  • Family Practice / statistics & numerical data*
  • Feedback*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Medical Records Systems, Computerized / statistics & numerical data*
  • Middle Aged
  • Oregon / epidemiology
  • Patient Education as Topic / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Physician-Patient Relations
  • Primary Health Care / organization & administration*
  • Primary Health Care / statistics & numerical data
  • Smoking / epidemiology
  • Smoking Cessation / methods*
  • Smoking Cessation / statistics & numerical data
  • Smoking Prevention*