Health System Implementation of a Tobacco Quitline eReferral

• Published in: Applied clinical informatics 2019-08, Vol.10 (4), p.735-742
• Main Authors: Hood-Medland, Eve Angeline, Stewart, Susan L., Nguyen, Hien, Avdalovic, Mark, MacDonald, Scott, Zhu, Shu-Hong, Mayoral, Antonio, Tong, Elisa K.
• Format: Article
• Language: English
• Subjects: Electronic Health Records; Humans; Nicotiana; Referral and Consultation - statistics & numerical data; Research Article; Smoking Cessation - statistics & numerical data; Telecommunications
• ISSN: 1869-0327; 1869-0327
• DOI: 10.1055/s-0039-1697593

Abstract Background  Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on “real-world” implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden. Objectives  This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system. Methods  This is a prospective implementation study of a health system tobacco eReferral to a state quitline that was completed with an approach to minimize provider cognitive burden. Data are drawn from electronic health record data at University of California, Davis Health Systems (March 2013–February 2016). Results  Over 3 years, 16,083 encounters with smokers resulted in 1,137 eReferral orders (7.1%). Treatment reach was 1.6% for quitline services and 2.3% for outpatient group classes. While the group classes were offered to outpatient smokers, the eReferral order was included in an outpatient order set and eventually an automated inpatient discharge order set; no provider alerts were implemented. Referrals were sustained and doubled after inpatient order set implementation. Among all first time eReferral patients, 12.2% had a 6 to 12 month follow-up visit at which they were documented as nonsmoking. Conclusion  This study demonstrates a quitline eReferral order can be successfully implemented and sustained with minimal promotion, without provider alerts and in conjunction with group classes. Reach and effectiveness were similar to previously described literature.