Stonesifer Connor, Crusco Salvatore, Rajupet Sritha
Vagelos College of Physicians and Surgeons, Columbia University, New York, United States.
Icahn School of Medicine at Mount Sinai, New York, United States.
Tob Prev Cessat. 2021 Feb 22;7:14. doi: 10.18332/tpc/131823. eCollection 2021.
Preoperative visits are an exceptional opportunity to encourage smoking cessation, as studies demonstrate the experience of scheduling elective surgery produces an actionable incentive to quit. However, studies suggest surgeons do not regularly assess smoking behavior or offer cessation therapies. Clinical decision support (CDS) is a system in which providers are presented with clinically integrated tools to enhance decision-making.
A CDS tool was designed to facilitate treatment referrals for smoking cessation services among patients seeking elective surgery. Two clinics were selected: the plastic and vascular surgeries. The study objectives were to assess the utilization rate and effectiveness of this system.
No smoking cessation referrals had been submitted by the plastic surgery or vascular surgery clinics in the year before CDS tool implementation. Providers at the plastic surgery clinic utilized the CDS tool in 95.0% (191 of 201) eligible patient encounters. Of these patients, 16.3% were identified as active smokers, and 16.1% of these smokers accepted treatment referrals. Providers at the vascular surgery clinic utilized the CDS tool in 50.3% (98 of 195) eligible patient encounters. Of these patients, 10.2% were identified as active smokers, and 30.0% of these smokers accepted treatment referrals.
The CDS tool improved the incidence of smoking cessation referrals in two surgical clinics from pretest baselines and achieved satisfactory utilization rates. This report demonstrates the feasibility of CDS tools to actualize the preoperative visit as an opportunity to promote smoking cessation.
术前访视是鼓励戒烟的绝佳时机，因为研究表明，安排择期手术的经历会产生促使患者戒烟的可行动力。然而，研究表明外科医生并不经常评估吸烟行为或提供戒烟治疗。临床决策支持（CDS）是一种为医疗服务提供者提供临床综合工具以增强决策能力的系统。
设计了一种CDS工具，以促进为寻求择期手术的患者提供戒烟服务的转诊。选择了两个诊所：整形外科和血管外科。研究目的是评估该系统的利用率和有效性。
在实施CDS工具前的一年里，整形外科或血管外科诊所均未提交戒烟转诊申请。整形外科诊所的医疗服务提供者在95.0%（201例中的191例）符合条件的患者诊疗中使用了CDS工具。在这些患者中，16.3%被确定为当前吸烟者，其中16.1%的吸烟者接受了治疗转诊。血管外科诊所的医疗服务提供者在50.3%（195例中的98例）符合条件的患者诊疗中使用了CDS工具。在这些患者中，10.2%被确定为当前吸烟者，其中30.0%的吸烟者接受了治疗转诊。
CDS工具提高了两家外科诊所从测试前基线开始的戒烟转诊发生率，并达到了令人满意的利用率。本报告证明了CDS工具将术前访视作为促进戒烟机会的可行性。
