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Implementation of an Electronic Health Record-Based Care Management System to Improve Tobacco Treatment

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ABSTRACT

BACKGROUND

Tobacco treatment is underused in primary care. We designed a Tobacco Care Management system to increase the delivery of treatment and reduce the burden on primary care providers (PCPs). A one-click functionality added to the electronic health record (EHR) allowed PCPs to refer smokers to a centralized tobacco treatment coordinator (TTC) who called smokers, provided brief counseling, connected them to ongoing treatment and gave feedback to PCPs.

OBJECTIVE

To study the system’s feasibility and acceptability among PCPs, and its utilization by smokers.

DESIGN

Using a mixed methods design, we documented system utilization quantitatively from February 1, 2010 to July 31, 2011, and conducted two focus groups with PCPs in June 2011.

PARTICIPANTS

Thirty-six PCPs and 2,894 smokers from two community health centers in Massachusetts.

MAIN MEASURES

Quantitative: One-click referral utilization by PCPs, proportion of smokers referred and connected to treatment. Qualitative: PCPs’ reasons for use, barriers to use, and experiences with feedback.

KEY RESULTS

Twenty-nine PCPs (81 %) used the functionality more than once, generating 466 referrals for 15 % of known smokers seen during the study. The TTC reached 260 (56 %) of the referrals and connected 135 (29 %) to additional treatment. The director of one center sent PCPs monthly feedback about their utilization compared to peers. These PCPs referred a greater proportion of their known smokers (18 % vs. 9 %, p < 0.0001) and reported that monthly feedback motivated referrals. PCPs attending focus groups (n = 24) appreciated the system’s simplicity, access to updated resources, and time-efficient way to address smoking, and wanted more feedback about cessation outcomes. They collectively supported the system’s continuation.

CONCLUSIONS

A novel EHR-based Tobacco Care Management system was adopted by PCPs, especially those receiving performance feedback, and connected one-third of referred smokers to treatment. The model has the potential to improve the delivery and outcomes of evidence-based tobacco treatment in primary care.

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Acknowledgements

We are grateful for the participation of the Community Health Centers, and wish to thank Southern Jamaica Plain Health Center, Charlestown Health Center, Michael Lambert, MD, and Mark Eisenberg, MD. We would also like to acknowledge Elizabeth Mort, MD, MPH and Partners HealthCare System’s High Performance Medicine for support of the project.

Partners Healthcare, Inc. funded the Tobacco Care Management program and supported the Tobacco Care coordinator. Dr. Kruse’s effort was supported by grant #T32HP12706-03-00 from the Health Resources and Services Administration for the Harvard General Medicine Fellowship. Dr. Rigotti’s effort was supported by NIH grant #K24-HL08880. The funders of these grants had no role in study design, conduct, data analysis, interpretation, or manuscript preparation, review, or approval.

An earlier version of this information was accepted for presentation as a poster at the Society for Research in Nicotine and Tobacco 18th Annual Meeting, Houston, Texas, March 15, 2012 and the Society for General Internal Medicine 35th Annual Meeting, Orlando, Florida May 12, 2012.

Conflict of Interest

The authors declare that they do not have a conflict of interest. Nancy A. Rigotti reports unpaid consultancy for Pfizer and Alere Wellbeing, research grants to MGH from Nabi Biopharmaceuticals and Pfizer, and royalties from UpToDate.

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Authors and Affiliations

  1. Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Gina R. Kruse MD, MS & Nancy A. Rigotti MD

  2. Harvard Medical School, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA

    Gina R. Kruse MD, MS, Jeffrey A. Linder MD, MPH, Elyse R. Park PhD, MPH & Nancy A. Rigotti MD

  3. Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Jennifer H. K. Kelley RN, MA, Elyse R. Park PhD, MPH & Nancy A. Rigotti MD

  4. High Performance Medicine, Partners HealthCare, Boston, MA, USA

    Jennifer H. K. Kelley RN, MA

  5. Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA

    Jeffrey A. Linder MD, MPH

  6. Mongan Institute for Health Policy, Boston, MA, USA

    Elyse R. Park PhD, MPH & Nancy A. Rigotti MD

  7. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Elyse R. Park PhD, MPH

Authors
  1. Gina R. Kruse MD, MS
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  2. Jennifer H. K. Kelley RN, MA
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  3. Jeffrey A. Linder MD, MPH
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  4. Elyse R. Park PhD, MPH
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  5. Nancy A. Rigotti MD
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Corresponding author

Correspondence to Gina R. Kruse MD, MS.

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Kruse, G.R., Kelley, J.H.K., Linder, J.A. et al. Implementation of an Electronic Health Record-Based Care Management System to Improve Tobacco Treatment. J GEN INTERN MED 27, 1690–1696 (2012). https://doi.org/10.1007/s11606-012-2174-6

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  • DOI: https://doi.org/10.1007/s11606-012-2174-6

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