Division of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
Nicotine Tob Res. 2024 Jul 22;26(8):1081-1088. doi: 10.1093/ntr/ntae023.
Our safety-net hospital implemented a hospital-based tobacco treatment intervention in 2016. We previously showed the intervention, an "opt-out" Electronic Health Record (EHR)-based Best Practice Alert (BPA)+ order-set that triggers consultation to an inpatient Tobacco Treatment Consult (TTC) service for all patients who smoke, improves smoking abstinence. We now report on sustainability, 6 years after inception.
We analyzed data collected between July 2016-June 2022 of patients documented as "currently smoking" in the EHR. Across the 6 years, we used Pearson's correlation analysis to compare Adoption (clinician acceptance of the BPA+ order-set, thus generating consultation to the TTC service); Reach (number of consultations completed by the TTC service); and Effectiveness (receipt of pharmacotherapy orders between patients receiving and not receiving consultations).
Among 39 558 adult admissions (July 2016-June 2022) with "currently smoking" status in the EHR for whom the BPA triggered, clinicians accepted the TTC order set on 50.4% (19 932/39 558), though acceptance varied across services (eg, Cardiology [71%] and Obstetrics-Gynecology 12%]). The TTC service consulted on 17% (6779/39 558) of patients due to staffing constraints. Consultations ordered (r = -0.28, p = .59) and completed (r = 0.45, p = .37) remained stable over 6-years. Compared to patients not receiving consultations, patients receiving consultations were more likely to receive pharmacotherapy orders overall (inpatient: 50.8% vs. 35.1%, p < .0001; at discharge: 27.1% vs. 10%, p < .0001) and in each year.
The "opt-out" EHR-based TTC service is sustainable, though many did not receive consultations due to resource constraints. Health care systems should elevate the priority of hospital-based tobacco treatment programs to increase reach to underserved populations.
Our study shows that opt-out approaches that utilize the EHR are a sustainable approach to providing evidence-based tobacco treatment to all hospitalized individuals who smoke, regardless of readiness to stop smoking and clinical condition.
我们的 2016 年建立的安全网医院实施了一项基于医院的烟草治疗干预措施。我们之前展示了该干预措施，即一种“选择退出”的电子健康记录 (EHR) 为基础的最佳实践警报 (BPA)+订单集，它会触发对所有吸烟患者的住院烟草治疗咨询 (TTC) 服务的咨询，提高了戒烟成功率。我们现在报告在启动后 6 年的可持续性。
我们分析了 2016 年 7 月至 2022 年 6 月期间 EHR 中记录为“当前吸烟”的患者的数据。在这 6 年中，我们使用皮尔逊相关分析来比较采用（临床医生接受 BPA+订单集，从而生成 TTC 服务的咨询）、覆盖范围（TTC 服务完成的咨询数量）和效果（接受咨询的患者与未接受咨询的患者之间的药物治疗订单）。
在 EHR 中，有 39558 名成人入院记录为“当前吸烟”，其中 BPA 触发了 50.4%（19932/39558）的临床医生接受了 TTC 订单集，尽管接受程度因服务而异（例如，心脏病学[71%]和妇产科 12%]）。由于人员配备限制，TTC 服务对 17%（6779/39558）的患者进行了咨询。咨询订单（r=−0.28，p=0.59）和完成（r=0.45，p=0.37）在 6 年内保持稳定。与未接受咨询的患者相比，接受咨询的患者总体上更有可能接受药物治疗订单（住院期间：50.8%对 35.1%，p<0.0001；出院时：27.1%对 10%，p<0.0001），且每年都有这种情况。
“选择退出”的基于 EHR 的 TTC 服务是可持续的，尽管由于资源限制，许多患者未接受咨询。医疗保健系统应提高基于医院的烟草治疗计划的优先级，以增加对服务不足人群的覆盖范围。
我们的研究表明，利用 EHR 的“选择退出”方法是为所有住院吸烟的个体提供基于证据的烟草治疗的一种可持续方法，无论他们是否准备戒烟和临床状况如何。
