Effect of systems change and use of electronic health records on quit rates among tobacco users in a public hospital system

Abstract

Objectives: We examined electronic health records (EHRs) to assess the impact of systems change on tobacco use screening, treatment, and quit rates among low-income primary care patients in Louisiana.

Methods: We examined EHR data on 79,777 patients with more than 1.2 million adult primary care encounters from January 1, 2009, through January 31, 2012, for evidence of systems change. We adapted a definition of "systems change" to evaluate a tobacco screening and treatment protocol used by medical staff during primary care visits at 7 sites in a public hospital system.

Results: Six of 7 sites met the definition of systems change, with routine screening rates for tobacco use higher than 50%. Within the first year, a 99.7% screening rate was reached. Sites had a 9.5% relative decrease in prevalence over the study period. Patients were 1.03 times more likely to sustain quit with each additional intervention (95% confidence interval = 1.02, 1.04).

Conclusions: EHRs can be used to demonstrate that routine clinical interventions with low-income primary care patients result in reductions in tobacco use and sustained quits.

FIGURE 1—

The Tobacco Control Initiative 5 A’s (ask, advise, assess, assess, assist, and arrange) protocol for tobacco intervention and parties responsible for each component: Louisiana State University Health New Orleans Health Care Services Division. Note. TCI = Tobacco Control Initiative.

FIGURE 2—

Percentage of primary care visits with recorded tobacco assessment: Louisiana State University Health New Orleans Health Care Services Division intervention sites, January 1, 2009–January 31, 2012. Note. BMC = Bogalusa Medical Center; EKL = Earl K. Long Medical Center; LAK = Lallie Kemp Medical Center; LJC = Leonard J. Chabert Medical Center; MCL = Medical Center of Louisiana; UMC = University Medical Center; WOM = Walter O. Moss Medical Center.