Patient Characteristics Associated With Smoking Cessation Interventions and Quit Attempt Rates Across 10 Community Health Centers With Electronic Health Records

Abstract

Objectives: We used electronic health record (EHR) data to determine rates and patient characteristics in offering cessation interventions (counseling, medications, or referral) and initiating quit attempts.

Methods: Ten community health centers in New York City contributed 30 months of de-identified patient data from their EHRs.

Results: Of 302 940 patients, 40% had smoking status recorded and only 34% of documented current smokers received an intervention. Women and younger patients were less likely to have their smoking status documented or to receive an intervention. Patients with comorbidities that are exacerbated by smoking were more likely to have status documented (82.2%) and to receive an intervention (52.1%), especially medication (10.8%). Medication, either alone (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.5, 2.3) or combined with counseling (OR = 1.8; 95% CI = 1.5, 2.3), was associated with higher quit attempts compared with no intervention.

Conclusions: Data from EHRs demonstrated underdocumentation of smoking status and missed opportunities for cessation interventions. Use of data from EHRs can facilitate quality improvement efforts to increase screening and intervention delivery, with the potential to improve smoking cessation rates.

FIGURE 1—

Documentation of smoking status and intervention by community health center: 10 New York City community health centers, 2009–2012. Note. Documentation of smoking status, smoking cessation intervention and quit attempt by community health center (CHC) varied widely. Bar graphs show proportion of population per CHC that were documented, identified as current smokers, given a cessation intervention, and attempted quit. For example, for CHC “A,” 78% of their patients had smoking status documented, nearly 46% were current smokers, 33% received an intervention (or 71% intervention rate with smokers), and fewer than 5% attempted to quit.