PURPOSE Practice transformation in primary care is a movement toward datadriven redesign of care, patient-centered care delivery, and practitioner activation. A critical requirement for achieving practice transformation is availability of tools to engage practices. METHODS A total of 48 practices with 109 practice sites participate in the Garden Practice Transformation Network in Maryland (GPTN-Maryland) to work together toward practice transformation and readiness for the Quality Payment Program implemented by the Centers for Medicare & Medicaid Services. Practice-specific data are collected in GPTN-Maryland by practices themselves and by practice transformation coaches, and are provided by the Centers for Medicare & Medicaid Services. These data are overwhelming to practices when presented piecemeal or together, a barrier to practices taking action to ensure progress on the transformation spectrum. The GPTN-Maryland team therefore created a practice transformation analytics dashboard as a tool to present data that are actionable in care redesign. RESULTS When practices reviewed their data provided by the Centers for Medicare & Medicaid Services using the dashboard, they were often seeing, for the first time, cost data on their patients, trends in their key performance indicator data, and their practice transformation phase. Overall, 72% of practices found the dashboard engaging, and 48% found the data as presented to be actionable. CONCLUSIONS The practice transformation analytics dashboard encourages practices to advance in practice transformation and improvement of patient care delivery. This tool engaged practices in discussions about data, care redesign, and costs of care, and about how to develop sustainable change within their practices. Research is needed to study the impact of the dashboard on costs and quality of care delivery.
Background: Recently, the use of electronic cigarettes increased sharply, leading to increased e-cigarette, or Vaping Product Use-Associated Lung Injury (EVALI), and other acute pulmonary conditions. There is an urgent need for clinical information about e-cigarette users to identify factors that contribute to EVALI. We developed an e-cigarette/vaping assessment tool (EVAT) that was integrated into the Electronic Health Record (EHR) of a large state-wide medical system and initiated a system-wide dissemination and education to support its use.Methods: EVAT documented current vaping status, history, and e-cigarette content (nicotine, cannabinoids, and/or flavoring). Educational materials and presentations were developed via a comprehensive literature review. EVAT utilization in the EHR was assessed quarterly. Patients' demographic data and clinical site name were also collected.Results: The EVAT was built, validated, and integrated with the EHR in July 2020. Live and virtual seminars were conducted for prescribing providers and clinical staff. Asynchronous training was offered using podcasts, e-mails, and Epic tip sheets. Participants were informed about vaping harm and EVALI and instructed on the use of EVAT. As of December 31, 2022, EVAT was used 988,181 times, with 376,559 unique patients evaluated. Overall, 1,063 hospital units and affiliated ambulatory clinics used EVAT, including 64 Primary Care, 95 Pediatrics, and 874 Specialty sites.Conclusions: EVAT was successfully implemented. Continued outreach efforts are needed to further increase its usage. Education materials should be enhanced to help providers to reach youth and vulnerable populations and connect patients to the tobacco treatment resources.
e-cigarettes/vape devices, tobacco cessation pharmacotherapeutics, tobacco treatment options, and EHR workflows. 2 Education occurred via grand rounds, departmental meetings, webinars, pre-recorded presentations, Epic tip sheets, and one-on-one academic detailing. Data from the Epic EHR were reviewed to identify the number of tobacco cessation e-referrals to the Maryland Quitline by physicians/practitioners across the UMMS in 2021. Physicians/practitioners who e-referred 10 or more patients in a 12-month period were considered "Tobacco Cessation Champions," and those who e-referred less than 10 patients were considered "Tobacco Cessation Advocates." Each physician/practitioner received a letter and certificate via e-mail celebrating their work and inspiring them to encourage their colleagues to e-refer their patients for tobacco cessation. Letters and certificates were tailored to Champions and Advocates, respectively. In 2021, 264 physicians/ practitioners e-referred patients to the Maryland Quitline. These physicians/practitioners received a letter and certificate in January 2022. There were 203 e-referrals submitted to the Maryland Quitline in the 4th quarter of 2021 and 269 e-referrals submitted to the Maryland Quitline in the 1st quarter of 2022. There were also 443 referrals to the Tobacco Health Practice in 2021. The sustainability of this effort is supported by having developed a scalable EHR workflow and training material existing in perpetuity. 4 LEARNING Positive reinforcement and acknowledgment of physicians'/practitioners' work to improve their patients' health may help increase tobacco cessation e-referrals. Physicians/practitioners self reported enthusiasm at being acknowledged for their effort. Access to accurate EHR data can be a valuable tool in quality improvement to improve clinical outcomes in vulnerable populations. 5 Recognition of physician/practitioner efforts can potentially be expanded beyond tobacco cessation to address other areas of practice. Future iterations of this effort should consider the proportion of patients who smoke and patients who do not require referral for treatment. Utilizing the rate of eligible smokers who need and are referred for treatment may produce a more accurate representation of physician/practitioner treatment efforts. Read or post comments in response to this article.
Context: Tobacco use remains a significant public health burden, especially in the face of the COVID-19 pandemic. Prior to the pandemic, the Maryland Tobacco Quitline (MDQL), an evidence-based cessation service, collaborated with the University of Maryland (UM) Department of Family Medicine to create a clinical decision support (CDS) tool. The tobacco cessation CDS created in the Epic electronic health record (EHR) allows providers to electronically refer (e-refer) patients to the MDQL. However, as the pandemic unfolded, an unexpected reduction was seen across the medical system in tobacco cessation e-referrals. Objective: This study explores trends in the number of e-referrals made via the CDS during the COVID-19 pandemic at UM Medical System (UMMS) practices. Study Design: A retrospective descriptive analysis. Setting or Dataset: MDQL data reports for primary care and specialty ambulatory practices in the University of Maryland Medical System. Population studied: Participants (N = 726) included outpatients e-referred for tobacco cessation to the MDQL through the Epic EHR. Outcome Measures: Tobacco cessation e-referrals generated by primary care and specialty providers, number of patients who accepted follow-up services from the MDQL, and number of patients who accepted nicotine replacement therapy (NRT). Results: Based on quarterly patient-level MDQL reports, 726 ereferrals were submitted by the UMMS from January 1, 2020 to December 31, 2020. Among them, 116 e-referrals (16%) were system-rejected due to duplicate referral or incomplete referral data, and 610 ereferrals (84%) were successfully transmitted. Among 610 transmitted referrals, 16.4% of patients accepted follow-up services. Among 100 patients who accepted MDQL services, 8 patients (8%) requested NRT and established a quit date, and 64 patients (64%) requested only NRT. The number of referrals reduced dramatically after the onset of the COVID-19 pandemic. Between 1st and 4th quarter 2020 there was a 54.3% reduction in e-referrals. Compared to 2019, there was a 32.1% reduction in ereferrals as of year-end 2020. Conclusions: Tobacco cessation e-referrals decreased throughout 2020, and overall compared to 2019, while healthcare providers shifted their focus from preventive medicine and primary care to COVID-19 related efforts. It will be important to urge providers to return to preventive medicine, screen all patients for tobacco use at every visit, and connect patients to cessation resources.
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