A Comparison of Smoking History in the Electronic Health Record With Self-Report

Patel, Nikhil; Miller, David P.; Snavely, Anna C.; Bellinger, Christina; Foley, Kristie L.; Case, Doug; McDonald, Malcolm; Masmoudi, Youssef; Dharod, Ajay

doi:10.1016/j.amepre.2019.10.020

Cited by 18 publications

(5 citation statements)

References 19 publications

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“…Because of the retrospective nature of this study, more comprehensive data of smoking status, for example, pack years, can be challenging to get from the electronic health records. 33…”

Section: Discussionmentioning

confidence: 99%

Low and Borderline Ankle–Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study

Laukka,

Kangas,

Kuusela

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: A low ankle–brachial index (ABI) has been linked to systemic inflammation and an elevated risk of cardiovascular events, most notably myocardial infarction and stroke. Intracranial aneurysms (IAs) share similar risk factors with other cardiovascular diseases. However, the association between low ABI and IAs has not been sufficiently investigated. Our objective was to investigate the potential connection between ABI values and the prevalence of unruptured IAs. METHODS: This retrospective cohort study reviewed 2751 patients who had ABI measurements at a public tertiary hospital from January 2011 to December 2013. Patients with available cerebrovascular imaging or a diagnosis of ruptured IA were included in the study (n = 776) to examine the association between ABI and saccular IAs. The patients were classified into 4 groups: low ABI (≤0.9, n = 464), borderline ABI (0.91-0.99; n = 47), high ABI (>1.4, n = 57), and normal ABI (1.00-1.40; n = 208). RESULTS: The prevalence of IAs was 20.3% (18.1% unruptured IAs) in the low ABI group, 14.9% (12.8% unruptured IAs) in the borderline ABI group, 7.0% (5.3% unruptured IAs) in the high ABI group, and 2.4% (1.9% unruptured IAs) in the normal ABI group (P < .001). There were no significant differences in the prevalence of ruptured IAs between the ABI groups (P = .277). Sex- and age-adjusted multinomial regression, including clinically relevant variables, revealed that low ABI (odds ratio [OR], 13.02; 95% CI, 4.01-42.24), borderline ABI (OR, 8.68; 95% CI, 2.05-36.69), and smoking history (OR, 2.01; 95% CI, 1.07-3.77) were associated with unruptured IAs. CONCLUSION: The prevalence of unruptured IAs was 9-fold higher in the low ABI group and nearly 7-fold higher in the borderline ABI group when compared with the normal ABI group. ABI measurements could be clinically relevant for identifying individuals at higher risk of IAs and may help guide screening and preventive strategies.

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“…Because of the retrospective nature of this study, more comprehensive data of smoking status, for example, pack years, can be challenging to get from the electronic health records. 33…”

Section: Discussionmentioning

confidence: 99%

Low and Borderline Ankle–Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study

Laukka,

Kangas,

Kuusela

et al. 2024

Neurosurgery

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“…Tobacco use status in electronic medical records will reflect the inconsistencies of the practices that collect this data. 16 Despite best practices to screen for tobacco use at every visit and update the medical record accordingly, 18 we recognized that many practices do not routinely capture tobacco use and may miss some tobacco users, and recent quitters might continue to be listed as current users.…”

Section: Study Samplementioning

confidence: 99%

“…14 Medical claims systems and EMR systems are likely to significantly under-report tobacco use status. 15,16 Aside from the known challenges with electronic medical records-based claims and reimbursement, 17 the potential revenue lost due to ineffective billing and underlying poor service delivery for cessation services remains largely unexplored. The lost revenue can be a marker for indicating sub-optimal interventions in health systems and quantifying the economic impact of missed tobacco cessation care.…”

Section: Introductionmentioning

confidence: 99%

Lost Opportunity in Tobacco Cessation Care: Impact of Underbilling in a Large Health System

Baughman,

Rauhut,

Anselm

2024

Preprint

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Importance: Tobacco cessation remains a critical challenge in healthcare despite the availability of evidence-based interventions, which are under-utilized. Tobacco cessation services can be provided and billed at every office visit, but full implementation is impeded by misaligned economic incentives and inadequate training. Objective: To evaluate the potential revenue loss in tobacco cessation care due to inadequate service delivery and billing practices, measuring the impact of systems-based approaches in population health for tobacco cessation. Methods: In this retrospective cohort study, aggregated de-identified patient-level health data was used to estimate smokers eligible for cessation counseling and analyze billing practices from 1/1/21 to 12/31/23. Using claims and electronic medical record data, potential revenue was calculated using the Medicare reimbursement rate and standard multipliers for smoking cessation services. Setting: Data across an 8-hospital regional health system with over 200 outpatient care locations across Pennsylvania and Maryland were examined. Participants: A total of 584,631 unique patients meeting inclusion criteria were identified, with 75,115 smokers eligible for cessation counseling. Intervention(s)/Exposure(s): Primary care encounters eligible for smoking cessation counseling (CPT codes 99406 or 99407) were analyzed over a three-year period. Main Outcome(s) and Measure(s): The billing rate for cessation counseling was calculated at both the patient and visit levels, revealing a discrepancy between eligible encounters and billed services. The estimated potential revenue loss over three years was $5,947,018.13. Results: Over the three years, 584,631 total primary care patients were seen. 75,115 (12.8%) were identified as smokers, who had 507,656 visits, and of these, only 1,277 patients were billed. This reflected a billing rate of 1.7%, with a potential unrealized revenue totaling $5,947,018.13 over three years. Conclusions and Relevance: The study identifies a disparity between potential and actual billing for smoking cessation, indicating missed opportunities for healthcare systems. This highlights a need for enhancing billing practices for smoking cessation, emphasizing the need for improved billing practices and systemic changes to enhance intervention efforts. Policy changes that incentivize proper billing could promote the public health benefits of improving smoking cessation interventions.

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“…For example, in an evaluation of the Veterans Health Administration demonstration project, 39% of patients who met the initial electronic medical record (EMR) screening criteria had missing or incorrectly recorded smoking data, rendering 36 555 people ineligible for further assessment 7 . Other studies have also found EMR records inadequate for determining screening eligibility in 30–50% of patients 99,101–103 and show that nurse‐led consultations are an effective strategy for obtaining smoking history. Data mining from hospital electronic health records may be able to mitigate inaccurate current smoking status to a certain extent 104 .…”

Section: Documentation Of Smoking Historymentioning

confidence: 99%

Lung cancer screening implementation: Complexities and priorities

2020

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Lung cancer is the number one cause of cancer death worldwide. The benefits of lung cancer screening to reduce mortality and detect early‐stage disease are no longer in any doubt based on the results of two landmark trials using LDCT. Lung cancer screening has been implemented in the US and South Korea and is under consideration by other communities. Successful translation of demonstrated research outcomes into the routine clinical setting requires careful implementation and co‐ordinated input from multiple stakeholders. Implementation aspects may be specific to different healthcare settings. Important knowledge gaps remain, which must be addressed in order to optimize screening benefits and minimize screening harms. Lung cancer screening differs from all other cancer screening programmes as lung cancer risk is driven by smoking, a highly stigmatized behaviour. Stigma, along with other factors, can impact smokers' engagement with screening, meaning that smokers are generally ‘hard to reach’. This review considers critical points along the patient journey. The first steps include selecting a risk threshold at which to screen, successfully engaging the target population and maximizing screening uptake. We review barriers to smoker engagement in lung and other cancer screening programmes. Recruitment strategies used in trials and real‐world (clinical) programmes and associated screening uptake are reviewed. To aid cross‐study comparisons, we propose a standardized nomenclature for recording and calculating recruitment outcomes. Once participants have engaged with the screening programme, we discuss programme components that are critical to maximize net benefit. A whole‐of‐programme approach is required including a standardized and multidisciplinary approach to pulmonary nodule management, incorporating probabilistic nodule risk assessment and longitudinal volumetric analysis, to reduce unnecessary downstream investigations and surgery; the integration of smoking cessation; and identification and intervention for other tobacco related diseases, such as coronary artery calcification and chronic obstructive pulmonary disease. National support, integrated with tobacco control programmes, and with appropriate funding, accreditation, data collection, quality assurance and reporting mechanisms will enhance lung cancer screening programme success and reduce the risks associated with opportunistic, ad hoc screening. Finally, implementation research must play a greater role in informing policy change about targeted LDCT screening programmes.

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A Comparison of Smoking History in the Electronic Health Record With Self-Report

Cited by 18 publications

References 19 publications

Low and Borderline Ankle–Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study

Low and Borderline Ankle–Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study

Lost Opportunity in Tobacco Cessation Care: Impact of Underbilling in a Large Health System

Lung cancer screening implementation: Complexities and priorities

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