A Computerized Aid to Support Smoking Cessation Treatment for Hospital Patients

Abstract

BACKGROUND: Hospital-based interventions promote smoking cessation after discharge. Strategies to deliver these interventions are needed, especially now that providing smoking cessation advice or treatment, or both, to inpatient smokers is a publicly reported quality-of-care measure for US hospitals. OBJECTIVE:To assess the effect of adding a tobacco order set to an existing computerized order-entry system used to admit Medicine patients to 1 hospital. DESIGN:Pre-post study. MEASUREMENTS AND MAIN RESULTS:Proportion of admitted patients who had smoking status identified, a smoking counselor consulted, or nicotine replacement therapy (NRT) ordered during 4 months before and after the change. In 4 months after implementation, the order set was used with 76% of Medicine admissions, and a known smoking status was recorded for 81% of these patients. The intervention increased the proportion of admitted patients who were referred for smoking counseling (0.8 to 2.1%) and had NRT ordered (1.6 to 2.5%) (p<.0001 for both). Concomitantly, the hospital's performance on the smoking cessation quality measure improved.CONCLUSIONS: Adding a brief tobacco order set to an existing computerized order-entry system increased a hospital's provision of evidence-based tobacco treatment and helped to improve its performance on a publicly reported quality measure. It provides a model for US hospitals seeking to improve their quality of care for inpatients.KEY WORDS: hospital medicine; medical informatics; physician behavior; smoking cessation; quality improvement.

Smoking Cessation Counseling for Parents During Child Hospitalization: A National Survey of Pediatric Nurses

“…More comprehensive policies that include referrals, written materials, and chart reminders may result in even greater rates of parent treatment for tobacco dependence. Not only have multiple randomized trials confirmed that computerized reminders increase outpatient preventive care (Koplan et al, 2008), but one recent study specifically showed that adding a tobacco order set to a hospital's existing computerized order entry system increased referral rates for smoking cessation and nicotine replacement therapy (Koplan, Regan, Goldszer, Schneider, & Rigotti, 2008). Increased access to written materials for parent smokers may also help increase routine cessation counseling by nurses.…”

Clinical Management of Tobacco Dependence in Inpatient Psychiatry: Provider Practices and Patient Utilization

“…Clinicians favored the provision of oral versus transdermal patch forms of NRT, and patients hospitalized on dual-diagnosis units were prescribed more NRT and higher doses compared with patients hospitalized on other units (10). Evidence from nonpsychiatric hospital settings indicates that staff training (11) and inclusion of NRT on computerized template orders (12) are associated with greater offering of NRT by providers, whereas consistent and persistent offering of NRT (13) and behavioral and motivational counseling (11,14) are associated with greater utilization of NRT among patients. [References citing additional evidence are listed online in a data supplement to this report.…”

Design and Testing of Tools for Shared Decision Making

“…In spillover, clinicians may adopt language or processes from the decision aid into their routine practice, thereby diluting differences between the intervention and usual care groups. 23,24 The majority of trials in the Cochrane review of decision aids were patient-level randomized trials. 3 Clustered randomized trials are particularly important for decision aids that are designed to be used within a clinical encounter.…”