Introduction: The shift from in-person care to telemedicine made it challenging to provide guideline-recommended tobacco cessation care during the COVID-19 pandemic. We described quality improvement (QI) initiatives for tobacco cessation during the COVID-19 pandemic, focusing on African American/Black patients with high smoking rates. Methods: The QI initiatives took place in the San Francisco Health Network, a network of 13 safety-net clinics in San Francisco, California between February 2020 and February 2022. We conducted direct patient outreach by telephone and increased staff capacity to increase cessation care delivery. We examined trends in tobacco screening, provider counseling, and best practice for cessation care (ie, the proportion of patients receiving at least 1 smoking cessation service during a clinical encounter). Results: In-person visits at the onset of the pandemic was 20% in April 2020 and increased to 67% by February 2022. During this time, tobacco screening increased from 29% to 74%. From March 2020 to March 2021, 34% more patients received provider counseling by telephone than in-person. The trend reversed from April 2021 to February 2022, where 23% more patients received counseling in-person than by telehealth. Best practice care increased by 23% from June 2020 to February 2022: 24% for African American/Black patients and 23% for other patients. Conclusions: Telehealth adaptations to the EHR, targeted outreach to patients, and a multi-disciplinary medical team may be associated with increases in cessation care delivery during the COVID-19 pandemic.

Highlights A quarter of adults who smoke made a cessation attempt in our safety-net system. Spanish-speaking and Latinx/Hispanic patients had higher odds of cessation attempts. Medicaid, older, and Chinese-speaking patients had lower odds of cessation attempts. Electronic health data can be used to inform cessation interventions and efficacy.

A simple strategy to reduce disparities in Covid-19 vaccination is to consistently offer the vaccine during primary care visits, a process that can be measured using standardized documentation practices.

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Background: Smoking cessation rates are low in safety-net settings, contributing to high smoking-related morbidity and mortality. Understanding factors associated with cessation attempts can inform interventions. Objective: To evaluate factors associated with smoking cessation attempts. Design: Retrospective analysis using electronic health record (EHR) data on individuals with at least three primary care encounters from 2016 to 2019 in the San Francisco Health Network (SFHN), a network of clinics serving publicly insured and uninsured residents in San Francisco.Participants: Patients engaged in primary care in the San Francisco Health Network.Main Measures: The outcome was recent cessation attempt, defined as change in smoking status from “current smoker” at the index visit to “former smoker” at visit 2 or 3. We measured demographics, tobacco-related comorbidities, and cessation treatment characteristics (i.e., counseling and pharmacotherapy). To better characterize subpopulations that may benefit from targeted interventions, we described characteristics of smokers with hypertension, depression, diabetes, or HIV.Key Results: Of the 51,554 adults identified across 15 SFHN primary care clinics, 11,622 (22.7%) were current smokers. Approximately 26% of smokers made a recent cessation attempt. Medical assistant (90%) and provider counseling (73%) rates were high, while behavioral assistant counseling rate (17%) was low. All counseling types had lower odds of cessation attempts in multivariable analysis. Smokers with depression (AOR 1.18, 95%CI 1.05-1.33) and ischemic heart disease (AOR 1.36, 95%CI 1.06-1.74) had higher odds of attempts. Among comorbidity groups, cessation attempts ranged from 21-26%, and smokers with HIV received the lowest rates of cessation counseling. Conclusions: Although rates of basic cessation counseling were high, efforts were associated with lower odds of making a cessation attempt. Using intensive interventions to target populations with comorbidities could be opportunities to increase cessation engagement.