title: Smoking-Cessation Assistance: Before and After Stage 1 Meaningful Use Implementation.
abstract: BACKGROUND
  Brief smoking-cessation interventions in primary care settings are effective, but delivery of these services remains low. The Centers for Medicare and Medicaid Services' Meaningful Use (MU) of Electronic Health Record (EHR) Incentive Program could increase rates of smoking assessment and cessation assistance among vulnerable populations. This study examined whether smoking status assessment, cessation assistance, and odds of being a current smoker changed after Stage 1 MU implementation.
  
  
  METHODS
  EHR data were extracted from 26 community health centers with an EHR in place by June 15, 2009. AORs were computed for each binary outcome (smoking status assessment, counseling given, smoking-cessation medications ordered/discussed, current smoking status), comparing 2010 (pre-MU), 2012 (MU preparation), and 2014 (MU fully implemented) for pregnant and non-pregnant patients.
  
  
  RESULTS
  Non-pregnant patients had decreased odds of current smoking over time; odds for all other outcomes increased except for medication orders from 2010 to 2012. Among pregnant patients, odds of assessment and counseling increased across all years. Odds of discussing or ordering of cessation medications increased from 2010 compared with the other 2 study years; however, medication orders alone did not change over time, and current smoking only decreased from 2010 to 2012. Compared with non-pregnant patients, a lower percentage of pregnant patients were provided counseling.
  
  
  CONCLUSIONS
  Findings suggest that incentives for MU of EHRs increase the odds of smoking assessment and cessation assistance, which could lead to decreased smoking rates among vulnerable populations. Continued efforts for provision of cessation assistance among pregnant patients is warranted.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon. Electronic address: bailstef@ohsu.edu.
authors.forename: Steffani R
authors.initials: SR
authors.lastname: Bailey
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: John D
authors.initials: JD
authors.lastname: Heintzman
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: OCHIN, Inc., Portland, Oregon.
authors.forename: R Lorie
authors.initials: RL
authors.lastname: Jacob
authors.affiliation: OCHIN, Inc., Portland, Oregon.
authors.forename: Jon E
authors.initials: JE
authors.lastname: Puro
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
authors.affiliation: Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
authors.forename: Tim E
authors.initials: TE
authors.lastname: Burdick
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Hazlehurst
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Fortmann
mesh_terms: D000328:Adult; D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data*; D003376:Counseling / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D062527:Meaningful Use / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D014481:United States / Q000453:epidemiology; D055815:Young Adult