title: Clinical Decision Support Tool for Parental Tobacco Treatment in Primary Care.
abstract: We created a clinical decision support (CDS) tool and evaluated its feasibility, acceptability, usability, and clinical impact within the electronic health record to help primary care pediatricians provide smoking cessation treatment to parents/caregivers who smoke.
  
  
  
  This prospective study of pediatric clinicians and parents was conducted at 1 urban primary care site. Clinicians received training in smoking cessation counseling, nicotine replacement therapy (NRT) prescribing, referral to an adult treatment program, and use of the CDS tool. The tool prompted clinicians to ask about secondhand smoke exposure, provide an electronic NRT prescription, and refer. Feasibility was measured by using electronic health record utilization data, and acceptability and usability were assessed with the use of clinician surveys. Parents reported clinical impact, including NRT accepted and used.
  
  
  
  From June to August 2015, clinicians used the tool to screen for secondhand smoke exposure at 2286 (76%) of 3023 visits. Parent smokers were identified at 308 visits, and 165 parents (55% of smokers) were interested in and offered treatment. Twenty-four (80%) of 30 eligible pediatric clinicians used the tool. Ninety-four percent of clinicians surveyed (n = 17) were satisfied with the tool, and the average system usability scale score was 83 of 100 (good to excellent range). We reached 69 of 100 parents sampled who received treatment; 44 (64%) received NRT, and 17 (25%) were currently using NRT.
  
  
  
  A CDS tool to help urban primary care pediatric clinicians provide smoking cessation treatment was feasible, acceptable, usable, and influenced clinical care. A larger scale investigation in varied practice settings is warranted.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA; and jenssenb@email.chop.edu.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Jenssen
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Tyra
authors.initials: T
authors.lastname: Bryant-Stephens
authors.affiliation: Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, Presbyterian Medical Center, Philadelphia, Pennsylvania.
authors.forename: Frank T
authors.initials: FT
authors.lastname: Leone
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA; and.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Grundmeier
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA; and.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Fiks
mesh_terms: D003376:Counseling; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D005240:Feasibility Studies; D006801:Humans; D010290:Parents / Q000523:psychology*; D000072143:Pediatricians; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D016540:Smoking Cessation / Q000379:methods; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*