Online Program

Cessation rates for community health centers using electronic health records

Tuesday, November 5, 2013

Sarah Shih, MPH, Primary Care Information Project, New York City Department of Health and Mental Hygiene, New York, NY
Jisung Cha, PhD, Primary Care Information Project, NYC DOHMH, Queens, NY
Sheryl Silfen, MD, Primary Care Information Project, NYC DOHMH, Queens, NY
Sung woo Lim, MS, DrPH, Bureau of Epidemiology Services, NYC Department of Health and Mental Hygiene, Queens, NY
Sam Amirfar, MD, MPH, Primary Care Information Project, NYC DOHMH, Queens, NY
Jason Wang, PhD, Primary Care Information Project, NYC Department of Health and Mental Hygiene, Long Island City, NY
Background. The Primary Care Information Project piloted a program to increase smoking cessation interventions. Community health centers with electronic health records (EHR) were enrolled in a cessation improvement program. Objective. Estimate cessation rates by intervention and patient demographics Method. De-identified data were collected on patients 18 years or older with smoking status recorded in an EHR structured field. "Quitting" was defined as smokers who changed from “current” to “former” smoker on a subsequent visit. Descriptive statistics and chi-square tests assessed differences in the receipt of cessation intervention by gender, age, race, insurance type. Optimal propensity score matching was used to adjust cessation rates by patient characteristics. Results. Of the 126,725 individual patients with smoking status recorded, 36,779 were current smokers; 12,638 received smoking cessation (counseling and/or medication). Patients receiving smoking cessation intervention tended to be black (50.1%), older (65.2%), and heavier smokers. Unadjusted quit rates were 5.0% for the no intervention population. After matching patient cohorts through a propensity scoring method, the odds of quitting smoking for smokers with any intervention compared to smokers with no intervention is 1.44 (95% CI [1.077,1.94] ). The odds of quitting for smokers with a cessation medication is highest compared to smokers without any medication intervention 2.4 (95% CI [1.60, 3.54]), followed with counseling intervention 1.57, [1.15, 2.15]). Discussion. Cessation interventions increased from 26.2% to 48.5%. Combined interventions with medication and counseling were associated with higher quit rates. Further reduction in smoking rates could be possible with focused delivery of combined cessation interventions.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health

Learning Objectives:
List potential interventions applied to smokers and which combination of cessation strategies are likely to have a higher quit rate. Describe methods used in the pilot program to estimate quit rates and areas where clinicians could still improve for addressing current smokers. Discuss whether additional education, resources, or incentives are needed to facilitate clinician’s delivery of effective cessation interventions, potential future programs to improve documentation of smoking status routinely and systematically for patients.

Keyword(s): Primary Care, Tobacco Control

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the program director for several evaluation projects that assess the impact of health information technology on health care quality and clinical preventive services.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.