Increases in Smoking Cessation Interventions in 19 Community Health Centers Following a Practice Feedback and Improvement Initiative Using Electronic Health Records—New York City, 2010-2012

October 17, 2014 / Vol. 63 / No. 41

MMWR Introduction

This analysis reports on an electronic health record-based pay-for-improvement initiative in 19 Community Health Centers (CHCs) in New York City (NYC) that sought to increase smoking status documentation and cessation interventions. At the end of the initiative, the mean proportion of patients who were documented as smokers in CHCs had increased from 24% to 27%, while the mean proportion of documented smokers who received a cessation intervention had increased from 23% to 54%. Public health programs and health systems should consider implementing strategies to equip and train clinical providers to use information technology to increase delivery of cessation interventions.

Electronic health records (EHRs) can facilitate clinical smoking cessation interventions in three ways. First, they can be used to prompt providers to screen for and document tobacco use and to intervene with tobacco users by integrating these steps into the clinical workflow. EHRs can also be used to facilitate provider referral of patients to state quitlines, which have broad reach, are effective with diverse populations, and increase quit rates. Second, EHR-generated patient lists can be used to supply providers and practices with rapid feedback on their tobacco screening and intervention performance; such feedback can motivate improvement in these areas, especially if performance is compared with other practices and tied to financial or other incentives. Third, EHRs can be used to track the impact of clinical cessation and health systems change initiatives on long-term outcomes in patient populations, including quit rates, smoking rates, and outpatient visits, and hospitalizations for smoking-related diseases.