Cessation rates for community health centers using electronic health records

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.