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5 A’s Tobacco Cessation Using a Primary Care Electronic
This evaluation grant examined the effects of Electronic Medical Record (EMR) generated provider performance feedback on referrals to the Oregon Tobacco Quit Line. The study involved 175 providers within 19 Providence owned clinics. Tobacco use status was added to the EMR as a vital sign and the rest of the 5A’s were added into the EMR as required fields. All clinics received training materials during a 30-minute session on the use of the updated EMR system as well as information on the 5As, pharmacotherapy options, and the quit line. Following this training, all clinics received access to the referral system to the Oregon Quit Line. Patients could be referred to the quit line in one of two ways: either via fax referral (provider faxed patient consent to be contacted directly to by the quit line) or via brochure (patients contact the quit line at their convenience). The intervention group received feedback on their performance which included provider rates on delivering 4 of the 5 A’s (Ask, Advise, Assess, and Assist). The provider received a graph depicting his/her rate, the local clinic rate, and the achievable benchmark of care rate, which was calculated based on the top 10% of performance for all providers. All incoming calls to the Quit Line were monitored to assess the quit line connections for each provider. Results indicated that feedback significantly increased the amount of documentation of the 5As in the EMR compared to control clinics. Quit line referrals and successful contacts also increased in the intervention group compared to the control group, when adjusted for cluster effects and other variables. Provider feedback can dramatically improve documentation rates and has a modest effect on quit line referral rates. The presence of a clinic champion and patient case mix (illness severity) influenced documentation and referral rates. Citations: Bentz CJ, Bayley KB, Bonin KE, Fleming L, Hollis JF, McAfee T. The Feasibility of Connecting Physician Offices to a State-Level Quit Line. 2006. Am J Preventive Med, 30(1):31-37. Bentz CJ, Bayley KB, Bonin KE, Fleming L, Hollis JF, Hunt JS, LeBlanc BH, McAfee T, Payne N, Siemienczuk J. Provider Feedback to Improve 5 A's Tobacco Cessation in Primary Care: A Cluster Randomized Clinical Trial. Nicotine and Tobacco Research. (In Press). For more information, contact: Charles J. Bentz, MD, FACP |
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