A Computerized Aid to Support Smoking Cessation Treatment for Hospital Patients

Harvard Medical School, Boston, MA, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 05/2008; 23(8):1214-7. DOI: 10.1007/s11606-008-0610-4
Source: PubMed


Hospital-based interventions promote smoking cessation after discharge. Strategies to deliver these interventions are needed, especially now that providing smoking cessation advice or treatment, or both, to inpatient smokers is a publicly reported quality-of-care measure for US hospitals.
To assess the effect of adding a tobacco order set to an existing computerized order-entry system used to admit Medicine patients to 1 hospital.
Pre-post study.
Proportion of admitted patients who had smoking status identified, a smoking counselor consulted, or nicotine replacement therapy (NRT) ordered during 4 months before and after the change. In 4 months after implementation, the order set was used with 76% of Medicine admissions, and a known smoking status was recorded for 81% of these patients. The intervention increased the proportion of admitted patients who were referred for smoking counseling (0.8 to 2.1%) and had NRT ordered (1.6 to 2.5%) (p < .0001 for both). Concomitantly, the hospital's performance on the smoking cessation quality measure improved.
Adding a brief tobacco order set to an existing computerized order-entry system increased a hospital's provision of evidence-based tobacco treatment and helped to improve its performance on a publicly reported quality measure. It provides a model for US hospitals seeking to improve their quality of care for inpatients.

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Available from: Susan Regan, Mar 20, 2015
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    • "Teams tended to be multidisciplinary and had the task of setting goals and reaching consensus on quality indicators prior to intervention. Five technical interventions were implemented by physicians [36,37,39-41], while in one study [35] the intervention was implemented by both nurses and physicians. "
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    ABSTRACT: Background Against a backdrop of rising healthcare costs, variability in care provision and an increased emphasis on patient satisfaction, the need for effective interventions to improve quality of care has come to the fore. This is the first ten year (2000–2010) systematic review of interventions which sought to improve quality of care in a hospital setting. This review moves beyond a broad assessment of outcome significance levels and makes recommendations for future effective and accessible interventions. Methods Two researchers independently screened a total of 13,195 English language articles from the databases PsychInfo, Medline, PubMed, EmBase and CinNahl. There were 120 potentially relevant full text articles examined and 20 of those articles met the inclusion criteria. Results Included studies were heterogeneous in terms of approach and scientific rigour and varied in scope from small scale improvements for specific patient groups to large scale quality improvement programmes across multiple settings. Interventions were broadly categorised as either technical (n = 11) or interpersonal (n = 9). Technical interventions were in the main implemented by physicians and concentrated on improving care for patients with heart disease or pneumonia. Interpersonal interventions focused on patient satisfaction and tended to be implemented by nursing staff. Technical interventions had a tendency to achieve more substantial improvements in quality of care. Conclusions The rigorous application of inclusion criteria to studies established that despite the very large volume of literature on quality of care improvements, there is a paucity of hospital interventions with a theoretically based design or implementation. The screening process established that intervention studies to date have largely failed to identify their position along the quality of care spectrum. It is suggested that this lack of theoretical grounding may partly explain the minimal transfer of health research to date into policy. It is recommended that future interventions are established within a theoretical framework and that selected quality of care outcomes are assessed using this framework. Future interventions to improve quality of care will be most effective when they use a collaborative approach, involve multidisciplinary teams, utilise available resources, involve physicians and recognise the unique requirements of each patient group.
    Full-text · Article · Aug 2012 · BMC Health Services Research
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    • "Identifying smoking status and recording increases the rate of clinical intervention, which has been shown to increase cessation attempts (Raw et al., 1998; Fiore et al., 2008). Automatic electronic medical records and decision-support systems could therefore, as facilitators of systematic interventions, improve hospital-based cessation support (Williams et al., 2005; Koplan et al., 2007). Implementing a tobacco measure in the national hospital quality-of-care standards, as is already the case in the United States, is also a crucial tool (Fiore et al., 2012). "
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    ABSTRACT: Background: Smoking cessation should be a top priority in hospitals. In November 2007, a Portuguese teaching hospital carried out a survey to evaluate cessation attitudes, clinical practices and cessation training needs among hospital-based healthcare providers (HCPs). The study also aimed to identify factors associated with cessation attitudes and practices, self-confidence to intervene and awareness of training programs. Method: This is a cross sectional questionnaire-based study including all HCPs. Sample: The study sample covers 424 HCPs, of which 65.4% were females. Mean age of these HCPs was 38.7 AE 10.1 years and the overall response rate was 50.5%. For data analyses, chi-squared tests, McNemar tests and multiple logistic regression models were used. Results: Most physicians and nurses reported "Asking" and "Advising" always or often. Other HCPs reported low frequencies of "Asking" and "Advising" (p < 0.001). Systematic "Asking" was reported less often than "Advising" (p < 0.001). Most HCPs did not record cessation practices, lacked specific training, and were not aware of their training needs. Reported self-confidence, positive attitudes and being a physician or non-smoker were the factors that influenced cessation practices the most. Conclusion: The findings suggest that there is reason to doubt that cessation practices are being under-taken effectively. Hospitals should audit smoking status recording, delivery of effective cessation advice and post-discharge support. Cessation indicators should be mandatory in all healthcare settings. To achieve these goals, undergraduate and graduate cessation training must be given higher priority.
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    ABSTRACT: Despite remaining the leading cause of preventable death in the United States, tobacco smoking does not garner the attention it deserves in the medical and public health communities. Smoking is often referred to merely as a “bad habit” that simply requires adequate willpower to conquer effectively. Fortunately, recent attitudes regarding smoking, as illustrated by the latest US Public Health Service Clinical Practice Guidelines, call for a “chronic disease model” for treating tobacco dependence. This article underscores the importance of viewing smoking as a chronic disease by illustrating the effects on morbidity and mortality, discussing the relapsing nature of addiction, outlining the need for continuum of care for different “severities” of illness, and describing the latest research regarding effective treatment components. Tobacco dependence treatments are safe, effective, and cost-saving, and their use should be encouraged and covered by health insurance analogous to other chronic conditions. KeywordsSmoking cessation-Tobacco dependence-Nicotine replacement-Cessation pharmacotherapy-Chronic disease model-Cardiovascular risk factor
    Full-text · Article · Nov 2010 · Current Cardiovascular Risk Reports
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