Provider feedback to improve 5A's tobacco cessation in primary care: a cluster randomized clinical trial.
The electronic health record (EHR) may be an effective tool to help clinicians address tobacco use more consistently. To evaluate the impact of EHR-generated practice feedback on rates of referral to a state-level tobacco quitline, we conducted a cluster randomized clinical trial (feedback versus no feedback) within 19 primary care clinics in Oregon. Intervention clinics received provider-specific monthly feedback reports generated from EHR data. The reports rated provider performance in asking, advising, assessing, and assisting with tobacco cessation compared with a clinic average and an achievable benchmark of care. During 12 months of follow-up, EHR-documented rates of advising, assessing, and assisting were significantly improved in the intervention clinics compared with the control clinics (p<.001). A higher case-mix index and presence of a clinic champion were associated with higher rates of referral to a state-level quitline. EHR-generated provider feedback improved documentation of assistance with tobacco cessation. Connecting physician offices to a state-level quitline was feasible and well accepted.
Bentz
Charles J
CJ
Providence/St. Vincent Hospital and Medical Center, Portland, OR 97225, USA. charles.bentz@providence.org
Bayley
K Bruce
KB
Bonin
Kerry E
KE
Fleming
Lori
L
Hollis
Jack F
JF
Hunt
Jacquelyn S
JS
LeBlanc
Benjamin
B
McAfee
Tim
T
Payne
Nicola
N
Siemienczuk
Joseph
J
D000328:Adult; D000368:Aged; D003376:Counseling / Q000706:statistics & numerical data; D005194:Family Practice / Q000458:organization & administration / Q000706:statistics & numerical data*; D005246:Feedback; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D000074606:Smoking Prevention