Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Community and Preventive Care Services, Gundersen Health System, La Crosse, Wisconsin, USA.
J Am Med Inform Assoc. 2019 Aug 1;26(8-9):778-786. doi: 10.1093/jamia/ocz044.
The study sought to determine whether interoperable, electronic health record-based referral (eReferral) produces higher rates of referral and connection to a state tobacco quitline than does fax-based referral, thus addressing low rates of smoking treatment delivery in health care.
Twenty-three primary care clinics from 2 healthcare systems (A and B) in Wisconsin were randomized, unblinded, over 2016-2017, to 2 smoking treatment referral methods: paper-based fax-to-quit (system A =6, system B = 6) or electronic (eReferral; system A = 5, system B = 6). Both methods referred adult patients who smoked to the Wisconsin Tobacco Quitline. A total of 14 636 smokers were seen in the 2 systems (system A: 54.5% women, mean age 48.2 years; system B: 53.8% women, mean age 50.2 years).
Clinics with eReferral, vs fax-to-quit, referred a higher percentage of adult smokers to the quitline: system A clinic referral rate = 17.9% (95% confidence interval [CI], 17.2%-18.5%) vs 3.8% (95% CI, 3.5%-4.2%) (P < .001); system B clinic referral rate = 18.9% (95% CI, 18.3%-19.6%) vs 5.2% (95% CI, 4.9%-5.6%) (P < .001). Average rates of quitline connection were higher in eReferral than F2Q clinics: system A = 5.4% (95% CI, 5.0%-5.8%) vs 1.3% (95% CI, 1.1%-1.5%) (P < .001); system B = 5.3% (95% CI, 5.0%-5.7%) vs 2.0% (95% CI, 1.8%-2.2%) (P < .001).
Electronic health record-based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates 3-4 times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals.
eReferral may help address the challenge of providing smokers with treatment for tobacco use during busy primary care visits.ClinicalTrials.gov; No. NCT02735382.
本研究旨在确定基于可互操作的电子健康记录的转介（eReferral）是否比基于传真的转介产生更高的转介率和与州烟草戒烟热线的联系率，从而解决医疗保健中低水平的吸烟治疗提供问题。
2016-2017 年，威斯康星州的 2 个医疗系统（A 和 B）的 23 个初级保健诊所被随机、非盲分配，采用 2 种吸烟治疗转介方法：纸质传真至戒烟热线（系统 A=6，系统 B=6）或电子（eReferral；系统 A=5，系统 B=6）。这两种方法都将吸烟的成年患者转介到威斯康星州烟草戒烟热线。在这 2 个系统中共见了 14636 名吸烟者（系统 A：54.5%女性，平均年龄 48.2 岁；系统 B：53.8%女性，平均年龄 50.2 岁）。
与传真至戒烟热线相比，使用 eReferral 的诊所将更高比例的成年吸烟者转介至戒烟热线：系统 A 诊所的转介率=17.9%（95%置信区间[CI]，17.2%-18.5%），而 3.8%（95% CI，3.5%-4.2%）（P<0.001）；系统 B 诊所的转介率=18.9%（95% CI，18.3%-19.6%），而 5.2%（95% CI，4.9%-5.6%）（P<0.001）。eReferral 诊所的戒烟热线连接率平均高于 F2Q 诊所：系统 A=5.4%（95% CI，5.0%-5.8%），而 1.3%（95% CI，1.1%-1.5%）（P<0.001）；系统 B=5.3%（95% CI，5.0%-5.7%），而 2.0%（95% CI，1.8%-2.2%）（P<0.001）。
基于电子健康记录的 eReferral 提供了一种有效的、闭环的、可互操作的转介吸烟患者至电话戒烟服务的方法，其转介率比当前的护理标准（传真转介）高 3-4 倍，包括对服务不足的个人的高转介率。
eReferral 可能有助于解决在繁忙的初级保健就诊期间为吸烟者提供烟草使用治疗的挑战。
ClinicalTrials.gov；编号 NCT02735382。
