Smoking Status Confirmation by Proxy: Validation in a Smoking Cessation Trial

Regan, Susan; Reid, Zachary Z.; Kelley, Jason; Reyen, Michele; Korotkin, Molly; Japuntich, Sandra J.; Viana, Joseph C.; Levy, Douglas E.; Rigotti, Nancy A.

doi:10.1093/ntr/ntv073

Cited by 11 publications

(11 citation statements)

References 15 publications

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“…Future efforts may consider tobacco registries to track tobacco status and outcomes after interventions. 44,45 The bidirectional eReferral feedback from a quitline can potentially contribute to such tobacco registries by tracking tobacco status at follow-up calls and describing interventions received. Interoperability between tobacco cessation EHR resources may be a model when developing clinical informatics tools, such as an open EHR.…”

Section: Discussionmentioning

confidence: 99%

Health System Implementation of a Tobacco Quitline eReferral

et al. 2019

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Background Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on “real-world” implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden. Objectives This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system. Methods This is a prospective implementation study of a health system tobacco eReferral to a state quitline that was completed with an approach to minimize provider cognitive burden. Data are drawn from electronic health record data at University of California, Davis Health Systems (March 2013–February 2016). Results Over 3 years, 16,083 encounters with smokers resulted in 1,137 eReferral orders (7.1%). Treatment reach was 1.6% for quitline services and 2.3% for outpatient group classes. While the group classes were offered to outpatient smokers, the eReferral order was included in an outpatient order set and eventually an automated inpatient discharge order set; no provider alerts were implemented. Referrals were sustained and doubled after inpatient order set implementation. Among all first time eReferral patients, 12.2% had a 6 to 12 month follow-up visit at which they were documented as nonsmoking. Conclusion This study demonstrates a quitline eReferral order can be successfully implemented and sustained with minimal promotion, without provider alerts and in conjunction with group classes. Reach and effectiveness were similar to previously described literature.

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Section: Discussionmentioning

confidence: 99%

Health System Implementation of a Tobacco Quitline eReferral

et al. 2019

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“…37–39 A recent analysis of proxy verification in a clinical trial suggests it is no more valid than self-report. 40 To examine the impact of proxy verification, the proportions of patients who verified abstinence via cotinine, CO, and proxy are reported.…”

Section: Methodsmentioning

confidence: 99%

Warm Handoff Versus Fax Referral for Linking Hospitalized Smokers to Quitlines

Richter

Faseru

Shireman

et al. 2016

American Journal of Preventive Medicine

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Introduction Few hospitals treat patients’ tobacco dependence. To be effective, hospital-initiated cessation interventions must provide at least 1 month of supportive contact post-discharge. Study design Individually randomized clinical trial. Recruitment commenced July 2011; analyses were conducted October 2014–June 2015. Setting/participants The study was conducted in two large Midwestern hospitals. Participants included smokers who were aged ≥18 years, planned to stay quit after discharge, and spoke English or Spanish. Intervention Hospital-based cessation counselors delivered the intervention. For patients randomized to warm handoff, staff immediately called the quitline from the bedside and handed the phone to participants for enrollment and counseling. Participants randomized to fax were referred on the day of hospital discharge. Main outcome measures Outcomes at 6 months included quitline enrollment/adherence, medication use, biochemically verified cessation, and cost effectiveness. Results Significantly more warm handoff than fax participants enrolled in quitline (99.6% vs 59.6%; relative risk, 1.67; 95% CI=1.65, 1.68). One in four (25.4% warm handoff, 25.3% fax) were verified to be abstinent at 6-month follow-up; this did not differ significantly between groups (relative risk, 1.02; 95% CI=0.82, 1.24). Cessation medication use in the hospital and receipt of a prescription for medication at discharge did not differ between groups; however, significantly more fax participants reported using cessation medication post-discharge (32% vs 25%, p=0.01). The average incremental cost-effectiveness ratio of enrolling participants into warm handoff was $0.14. Hospital-borne costs were significantly lower in warm handoff than in fax ($5.77 vs $9.41, p<0.001). Conclusions One in four inpatient smokers referred to quitline by either method were abstinent at 6 months post-discharge. Among motivated smokers, fax referral and warm handoff are efficient and comparatively effective ways to link smokers with evidence-based care. For hospitals, warm handoff is a less expensive and more effective method for enrolling smokers in quitline services.

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“…Responses were compared with self-reported smoking history completed by the corresponding patient or relative(s). Owing to the unavailability of biochemical measures of smokingdoften used as a gold standard in smoking cessation studies 16 dself-reported cigarette smoking history was treated as "truth." Specificity, sensitivity, and accuracy analyses were performed to compare patient and relative reports with self-reports for the question, "Have you ever smoked cigarettes (more than 100 in your lifetime)?"…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Smoking Status Reporting

Stevens

Rabe

Boursi

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective To assess whether patients and relatives can serve as reliable proxy reporters of other family members’ cigarette-smoking history. Patients and Methods Two samples (325 patients, 707 relatives) were identified from the Mayo Clinic Biospecimen Resource for Pancreas Research, enrolled from November, 6, 2000, to March 15, 2018. Smoking-history data, including categorical (ever/never) and quantitative (packs per day and years smoked) smoking measures, were obtained from self-completed questionnaires by patients and relatives. Relative reports were compared with patient reports on self; patient reports were compared with relative reports on self. Results Overall, spouses and first-degree relatives (FDRs) were accurate (94.5%) when reporting patient ever smoking; spouse reports were 98.6% sensitive and 97.7% accurate. Accuracy of patient reports was 97.8% for spouse smoking and 85.5% for FDR smoking; accuracy varied by relationship of FDR. When not concordant, patients generally over-reported daily packs smoked by relatives and under-reported years smoked. Within a 25% agreement range, spouse reports about patients’ daily packs smoked was 46.7%, and years smoked was 69.6%, whereas FDRs were 50% and 64.6%, respectively. When not concordant, relatives generally over-reported daily packs smoked by patients, but no consistent pattern was observed of over- or under-reporting years smoked by patients. Conclusions Patients and relatives can be reliable proxies for smoking history (ever/never) in their family members, especially spouses. An accurate reporting of smoking status will help physicians to better gauge performance status and family smoking exposures to inform disease management.

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Smoking Status Confirmation by Proxy: Validation in a Smoking Cessation Trial

Cited by 11 publications

References 15 publications

Health System Implementation of a Tobacco Quitline eReferral

Health System Implementation of a Tobacco Quitline eReferral

Warm Handoff Versus Fax Referral for Linking Hospitalized Smokers to Quitlines

Accuracy of Smoking Status Reporting

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