title: Effect of systems change and use of electronic health records on quit rates among tobacco users in a public hospital system.
abstract: OBJECTIVE
  We examined electronic health records (EHRs) to assess the impact of systems change on tobacco use screening, treatment, and quit rates among low-income primary care patients in Louisiana.
  
  
  METHODS
  We examined EHR data on 79,777 patients with more than 1.2 million adult primary care encounters from January 1, 2009, through January 31, 2012, for evidence of systems change. We adapted a definition of "systems change" to evaluate a tobacco screening and treatment protocol used by medical staff during primary care visits at 7 sites in a public hospital system.
  
  
  RESULTS
  Six of 7 sites met the definition of systems change, with routine screening rates for tobacco use higher than 50%. Within the first year, a 99.7% screening rate was reached. Sites had a 9.5% relative decrease in prevalence over the study period. Patients were 1.03 times more likely to sustain quit with each additional intervention (95% confidence interval = 1.02, 1.04).
  
  
  CONCLUSIONS
  EHRs can be used to demonstrate that routine clinical interventions with low-income primary care patients result in reductions in tobacco use and sustained quits.
authors.affiliation: Sarah Moody-Thomas and Michael D. Celestin, Jr, are with the Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans. Laura Nasuti is with the Bureau of Community Health & Prevention, Massachusetts Department of Public Health, Boston. Yong Yi is with the Louisiana State University Health Care Services Division, Baton Rouge. Ronald Horswell is with the Healthcare Quality Improvement Lab, Pennington Biomedical Research Center, Baton Rouge. Thomas G. Land is with the Office of Health Information Policy and Informatics, Massachusetts Department of Public Health, Boston.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moody-Thomas
authors.forename: Laura
authors.initials: L
authors.lastname: Nasuti
authors.forename: Yong
authors.initials: Y
authors.lastname: Yi
authors.forename: Michael D
authors.initials: MD
authors.lastname: Celestin
authors.forename: Ronald
authors.initials: R
authors.lastname: Horswell
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Land
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008145:Louisiana; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011203:Poverty; D015995:Prevalence; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D017150:Public Sector; D012907:Smoking / Q000453:epidemiology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D055815:Young Adult