Effect of Systems Change and Use of Electronic Health Records on Quit Rates Among Tobacco Users in a Public Hospital System

Moody–Thomas, Sarah; Nasuti, Laura; Yi, Yong Jeong; Celestin, Michael D.; Horswell, Ronald; Land, Thomas

doi:10.2105/ajph.2014.302274

Cited by 14 publications

(10 citation statements)

References 19 publications

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“… Technology complex - External validity limited: Study conducted in the correctional setting. - Financial assistance Financial Assistance - Interoperability Interoperability Chambers, et al [ 24 ] - Improvement to quality Quality - None identified None identified - Selection bias - Surveillance Surveillance - Gender bias - Access to primary care information provides tailored quality improvement initiatives Productivity/ Efficiency - External validity limited because the gender/race demographics of the sample are not representative of the U.S. Moody-Thomas, et al [ 25 ] - Improved primary care Quality - No independent method for determining the quality of data No standards - Quasi-experimental - Intervention effective in lowering the prevalence of tobacco Health Outcomes - Patient-reported behavior on bad behavior can be tempered to avoid uncomfortable discussions. - Disease prevention Preventative Care - No similar group exists for comparison of results.…”

Section: Resultsmentioning

confidence: 99%

The use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature

et al. 2018

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Electronic health records (EHRs) have emerged among health information technology as “meaningful use” to improve the quality and efficiency of healthcare, and health disparities in population health. In other instances, they have also shown lack of interoperability, functionality and many medical errors. With proper implementation and training, are electronic health records a viable source in managing population health? The primary objective of this systematic review is to assess the relationship of electronic health records’ use on population health through the identification and analysis of facilitators and barriers to its adoption for this purpose. Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE (PubMed), 10/02/2012–10/02/2017, core clinical/academic journals, MEDLINE full text, English only, human species and evaluated the articles that were germane to our research objective. Each article was analyzed by multiple reviewers. Group members recognized common facilitators and barriers associated with EHRs effect on population health. A final list of articles was selected by the group after three consensus meetings (n = 55). Among a total of 26 factors identified, 63% (147/232) of those were facilitators and 37% (85/232) barriers. About 70% of the facilitators consisted of productivity/efficiency in EHRs occurring 33 times, increased quality and data management each occurring 19 times, surveillance occurring 17 times, and preventative care occurring 15 times. About 70% of the barriers consisted of missing data occurring 24 times, no standards (interoperability) occurring 13 times, productivity loss occurring 12 times, and technology too complex occurring 10 times. The analysis identified more facilitators than barriers to the use of the EHR to support public health. Wider adoption of the EHR and more comprehensive standards for interoperability will only enhance the ability for the EHR to support this important area of surveillance and disease prevention. This review identifies more facilitators than barriers to using the EHR to support public health, which implies a certain level of usability and acceptance to use the EHR in this manner. The public-health industry should combine their efforts with the interoperability projects to make the EHR both fully adopted and fully interoperable. This will greatly increase the availability, accuracy, and comprehensiveness of data across the country, which will enhance benchmarking and disease surveillance/prevention capabilities.

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Section: Resultsmentioning

confidence: 99%

The use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature

et al. 2018

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“… Horbar et al [ 30 ] Newborns received first dose of surfactant sooner compared to previous period (21 vs. 78 min post birth, p < 0.001). Kegler et al [ 25 ] More collaborative working practices Khan et al [ 31 ] Reduction in average brain function impediment score, drop from 19.21 to 14.75 MacKenzie et al [ 32 ] Turnaround time for beds reduced 210 to 54 min in 2004, maintained (2007) Moody-Thomas et al [ 33 , 34 ] Smoking quit rates increased from 5.0 % in 2008 to 9.6 % in 2009. Parchman et al [ 48 , 49 ], Noël et al [ 47 ] Significant and sustained improvement in ACIC scores for chronic care: from 5.58 to 6.33 to 6.60 (group 1) or 5.27 to 5.99 (group 2), both p < 0.05.…”

Section: Resultsmentioning

confidence: 99%

“…Fears of the unknown and difficulty in maintaining a chain of accountability were mentioned [ 11 , 41 ]. Without specific targets, some participants feared unstated institutional motives [ 42 ] or felt pointlessly imposed upon [ 34 ]. Other barriers to successful implementation were individuals’ resistance to change [ 24 , 33 , 34 , 41 , 44 , 47 ], reluctance by senior staff to yield to collaborative decision-making [ 24 , 27 , 47 ] and lack of financial incentives [ 47 ] or external facilitation [ 11 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

Do complexity-informed health interventions work? A scoping review

Brainard

Hunter

2015

Implementation Sci

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BackgroundThe lens of complexity theory is widely advocated to improve health care delivery. However, empirical evidence that this lens has been useful in designing health care remains elusive. This review assesses whether it is possible to reliably capture evidence for efficacy in results or process within interventions that were informed by complexity science and closely related conceptual frameworks.MethodsSystematic searches of scientific and grey literature were undertaken in late 2015/early 2016. Titles and abstracts were screened for interventions (A) delivered by the health services, (B) that explicitly stated that complexity science provided theoretical underpinning, and (C) also reported specific outcomes. Outcomes had to relate to changes in actual practice, service delivery or patient clinical indicators. Data extraction and detailed analysis was undertaken for studies in three developed countries: Canada, UK and USA. Data were extracted for intervention format, barriers encountered and quality aspects (thoroughness or possible biases) of evaluation and reporting.ResultsFrom 5067 initial finds in scientific literature and 171 items in grey literature, 22 interventions described in 29 articles were selected. Most interventions relied on facilitating collaboration to find solutions to specific or general problems. Many outcomes were very positive. However, some outcomes were measured only subjectively, one intervention was designed with complexity theory in mind but did not reiterate this in subsequent evaluation and other interventions were credited as compatible with complexity science but reported no relevant theoretical underpinning. Articles often omitted discussion on implementation barriers or unintended consequences, which suggests that complexity theory was not widely used in evaluation.ConclusionsIt is hard to establish cause and effect when attempting to leverage complex adaptive systems and perhaps even harder to reliably find evidence that confirms whether complexity-informed interventions are usually effective. While it is possible to show that interventions that are compatible with complexity science seem efficacious, it remains difficult to show that explicit planning with complexity in mind was particularly valuable. Recommendations are made to improve future evaluation reports, to establish a better evidence base about whether this conceptual framework is useful in intervention design and implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0492-5) contains supplementary material, which is available to authorized users.

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“…Advances in electronic health record implementation and other health information technology systems enable greater consistency in documentation of measures of health, including tobacco use status. 21 Research suggests that computer-based alerts improve provider likelihood of adhering to practice guidelines. 22 , 23 While the consult service continues to grow, both in numbers of providers ordering consults and number of patients for whom orders are submitted, there are ways that the electronic medical record system could be used to help capture even more of the patients who use tobacco.…”

Section: Discussionmentioning

confidence: 99%

Provider satisfaction with an inpatient tobacco treatment program: results from an inpatient provider survey

Trout¹,

Ripley‐Moffitt²,

Meernik³

et al. 2017

IJGM

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BackgroundHospitalization offers an optimal environment for ensuring that patients receive evidence-based treatment. An inpatient tobacco treatment program can deliver interventions broadly, but minimal research has examined the impacts of a consult program on inpatient providers. The Nicotine Dependence Program at the University of North Carolina has provided an inpatient tobacco treatment consult service since 2010.ObjectiveThe program sought feedback from inpatient providers to examine factors that prompted tobacco treatment consult orders, the impact on provider counseling behavior, provider satisfaction, and suggested program improvements.DesignProviders who had ordered a tobacco treatment consult received an online anonymous survey.SettingThe University of North Carolina Hospital is an academic medical facility with 803 beds and over 37,000 inpatient admissions annually from all 100 counties in North Carolina. Approximately 20% of these inpatients report current use of any tobacco product.Patients/participantsMedical providers who ordered inpatient tobacco treatment consults from July 2012 to June 2013 (n=265) received the survey, with 118 providers responding (44.5% response rate).ResultsAlmost all providers reported being satisfied with the consult program and believed it was effective. Key factors in provider satisfaction included ease of accessing the service, saving provider time, and offering patients evidence-based tobacco use treatment. The consult program increased the likelihood of providers prescribing tobacco cessation medications at discharge, as well as following up at post-discharge appointments.ConclusionThis is some of the first research to show provider satisfaction, program usage, and outcomes with an inpatient tobacco treatment program and demonstrates the important impact of implementing tobacco treatment services within hospitals.

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Effect of Systems Change and Use of Electronic Health Records on Quit Rates Among Tobacco Users in a Public Hospital System

Abstract: EHRs can be used to demonstrate that routine clinical interventions with low-income primary care patients result in reductions in tobacco use and sustained quits.

Cited by 14 publications

References 19 publications

The use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature

The use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature

Do complexity-informed health interventions work? A scoping review

Provider satisfaction with an inpatient tobacco treatment program: results from an inpatient provider survey

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