Sustainability of an Opt-Out Electronic-Health Record-Based Tobacco Treatment Consult Service at a Large Safety-Net Hospital: A 6-Year Analysis.

Autor:	Flores A; Division of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Wiener RS; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA.; Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Hon S; Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts University School of Medicine, Boston, MA, USA., Wakeman C; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA., Howard J; Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Virani N; Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Mattus B; Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Foreman AG; Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Singh J; Research Computing Services (RCS) Group, Information Services & Technology, Boston University, Boston, MA, USA., Rosen L; Clinical Data Warehouse, Boston Medical Center, Boston, MA, USA., Bulekova K; Research Computing Services (RCS) Group, Information Services & Technology, Boston University, Boston, MA, USA., Kathuria H; Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco [Nicotine Tob Res] 2024 Jul 22; Vol. 26 (8), pp. 1081-1088.
DOI:	10.1093/ntr/ntae023
Abstrakt:	Introduction: 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. Aims and Methods: 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). Results: 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. Conclusions: 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. Implications: 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. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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