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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Judith N. Sabino, MPH1, Suzanne L. Smith, MBA1, Julie Dostal, MD2, Alice DallaPalu, MPA, CAC3, Lawrence C. Kleinman, MD, MPH4, Mark J. Young, MD5, Marna Greenberg, DO6, and Eric J. Gertner, MD MPH7. (1) Department of Community Health and Health Studies, Lehigh Valley Hospital, 17th and Chew Streets, PO Box 7017, Allentown, PA 18105-7017, 610-402-2444, judith.sabino@lvh.com, (2) Department of Family Practice, Lehigh Valley Hospital, 17th and Chew Streets, P.O. Box 7017, Allentown, PA 18105-7017, (3) Lehigh Valley Hospital, Coalition for a Smoke Free Valley, 17th and Chew Streets, P.O. Box 7017, Allentown, PA 18105-7017, (4) Health Studies Unit, Lehigh Valley Hospital and Health Network, 17th & Chew Streets, Allentown, PA 18105, (5) Department of Community and Health Studies, Lehigh Valley Hospital, Penn State University College of Medicine, 227 North 17th Street, Allentown, PA 18104, (6) Lehigh Valley Hospital, Department of Emergency Medicine, P.O. Box 689, Allentown, PA 18105, (7) Division of General Internal Medicine, Lehigh Valley Hospital, Allentown (PA), 1210 South Cedar Crest Blvd, Suite 3600, Allentown, PA 18103
Background: Provision of brief advice and follow-up care for all smokers has proven successful in aiding tobacco cessation attempts. Screening rates for tobacco use by health care providers remain low despite national guidelines.
Objective: To determine the impact of educational interventions for clinicians and simple redesign of patient assessment forms on the rate of tobacco use screening and referral provided by clinicians as documented on ambulatory care charts in three settings (emergency department [ED], family practice [FP] and internal medicine [IM] practice) at Lehigh Valley Hospital, a premier academic community hospital in Allentown, Pennsylvania.
Methods: Tobacco screening and advice/referral rates were determined through randomized medical record review. We reviewed 652 charts at baseline and 650 charts at follow up to determine the rates of screening for tobacco use and subsequent advice and referral for those reporting use. Charts were reviewed in the ED (340 pre-intervention and 288 post-intervention, excluding acutely ill patients), FP (140 pre-intervention and 170 post-intervention) and IM (172 pre-intervention and 192 post-intervention). The educational intervention consisted of 60- to 120-minute didactic presentations to physicians, residents, nurses and ancillary health care providers. Patient assessment form modifications to document tobacco use and readiness of change were made in collaboration with practice staff. Results: Randomly selected charts for patients 15 years and older were reviewed in all sites. In the ED, tobacco screening rates improved from 39% at baseline to 56% at the post-intervention period. In the IM practice, rates improved from 81% to 94%. FP data remained similar from 89% to 91% respectively. Advice/referral rates for tobacco users were from 0% to 11% in the ED, 24% to 36% in the FP and 22% to 32% in IM.
Conclusion: Screening for tobacco use increased in the ED and IM and remained high in FP. Advice and referral rates improved from baseline in all settings. These interventions appear to be effective although they do not eliminate disparities in rates between the settings.
Learning Objectives:
Keywords: Quality Improvement, Tobacco Control
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.