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

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


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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Community Health Services / organization & administration*
  • Electronic Health Records / statistics & numerical data*
  • Feedback
  • Female
  • Focus Groups
  • Health Plan Implementation / methods
  • Humans
  • Male
  • Massachusetts
  • Middle Aged
  • Patient Care Team / organization & administration
  • Patient Compliance / statistics & numerical data
  • Primary Health Care / organization & administration*
  • Program Evaluation
  • Quality Improvement
  • Referral and Consultation / statistics & numerical data*
  • Smoking Cessation / methods*
  • Treatment Outcome