EHR-Based and Fax-Based Referral to a Tobacco Quitline: A Comparative Study

NCT02735382 | Completed Results

• 2 other identifiers: 2015-08441R35CA197573-01
• Study Type: interventional
• Target: 14,930
• Locations: 1 country
• Sites: 1

Brief Summary

This study is designed to assess whether completely electronic, HIPAA-compliant, EHR-based, closed-loop referrals for tobacco cessation from primary care clinics to a state telephone tobacco quitline service can increase the number/percentage of adult tobacco users receiving evidence-based tobacco dependence treatment when compared to paper-based fax referrals. This study also will survey clinic staff to evaluate satisfaction with the referral process.

Conditions

Tobacco Use Cessation; Tobacco Smoking

Keywords

Translational Medical Research; Clinical Practice Guidelines; Electronic Health Records; Smoking; Tobacco; Quitline

Outcome Measures

Primary Outcomes (1)

• Number of Participants Referred

  EHR-based vs. Fax-based rates of referral of adult tobacco users visiting primary care clinics to the tobacco quitline. The rate of referral will be determined by the ratio of total referrals to total smokers identified in the clinic's EHR over a period of 6 months of study observation.

  Rates come from cumulative data collected over the course of 6 months.

Secondary Outcomes (3)

• Number of Participants Meeting Criteria for Quality Referral

  Rates come from cumulative data collected over the course of 6 months.

• Number of Participants Self-reporting Smoking Abstinence

  7-day point prevalence smoking outcomes at 4-months after participant registration with the WI Tobacco Quit Line.

• Change in Global Staff Satisfaction With the Referral Intervention

  Satisfaction measures will be surveyed at baseline and at 6 months and reported as a single change score

Study Arms (4)

EHR-based referral to quit line

EXPERIMENTAL

Clinics will use an EHR-based fully-electronic HIPAA-compliant tool to refer their adult patients who use tobacco to the telephone tobacco quitline for tobacco cessation counseling and medication. Intervention: Behavioral: Tobacco quitline EHR referral

Behavioral: Tobacco quitline EHR referral

Fax-based referral to quit line

ACTIVE COMPARATOR

Clinics will use a paper fax tool to refer their adult patients who use tobacco to the telephone tobacco quitline for tobacco cessation counseling and medication. Intervention: Behavioral: Tobacco quitline Fax referral

Behavioral: Tobacco quitline Fax referral

EHR-based Clinic Staff

EXPERIMENTAL

Clinics will use an EHR-based fully-electronic HIPAA-compliant tool to refer their adult patients who use tobacco to the telephone tobacco quitline for tobacco cessation counseling and medication. Staff in these clinics will complete surveys to address Aim 4 of the study.

Behavioral: Tobacco quitline EHR referral

Fax-based referral to quit line Clinic Staff

ACTIVE COMPARATOR

Clinics will use a paper fax tool to refer their adult patients who use tobacco to the telephone tobacco quitline for tobacco cessation counseling and medication. Staff in these clinics will complete surveys to address Aim 4 of the study.

Behavioral: Tobacco quitline Fax referral

Interventions

Tobacco quitline EHR referral BEHAVIORAL

Using an EHR-based referral to the tobacco quitline from primary care outpatient clinics.

EHR-based Clinic Staff; EHR-based referral to quit line

Tobacco quitline Fax referral BEHAVIORAL

Using an Fax--based referral to the tobacco quitline from primary care outpatient clinics.

Fax-based referral to quit line; Fax-based referral to quit line Clinic Staff

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• The presence of discrete primary care clinical services within the clinic (defined as general internal medicine or family medicine clinical services);
• At least three primary care clinician providers in the clinic (physicians or nurse practitioners/physician assistants who see patients independently of a physician);
• A total primary care clinical volume of at least 60 patients each week;
• An existing EHR requirement for staff to document tobacco use status including smoking status on all adult patients visiting the clinic at every visit;
• A capacity to enumerate patient visit information including adult patients/month and adult tobacco users/month by clinician and by clinic;
• A willingness to participate in the proposed research;
• A lead physician or a clinic manager on site who agree to serve as a clinic champion for the project;
• Prior use of the fax referral system to refer patients to the Wisconsin Tobacco Quit Line with use data available for the 12 months prior to study launch;
• A willingness to accept random assignment to either of the two experimental conditions.

You may not qualify if:

• Those clinics not meeting the above criteria (e.g. too small, limited EHR capacity).
• (Note: In this study, the clinics are the "subjects" under study. The patients that will be referred by the clinic to the Wisconsin Tobacco Quit Line will be least 18 years old and Cigarette smokers)

Sponsors & Collaborators

• University of Wisconsin, Madison: lead
• National Cancer Institute (NCI): collaborator

Study Sites (1)

University of Wisconsin Center for Tobacco Research and Intervention, School of Medicine and Public Health

Madison, Wisconsin, 57311-2027, United States

Location

Related Publications (2)

• Zehner ME, Kirsch JA, Adsit RT, Gorrilla A, Hayden K, Skora A, Rosenblum M, Baker TB, Fiore MC, McCarthy DE. Electronic health record closed-loop referral ("eReferral") to a state tobacco quitline: a retrospective case study of primary care implementation challenges and adaptations. Implement Sci Commun. 2022 Oct 8;3(1):107. doi: 10.1186/s43058-022-00357-4.

  PMID: 36209149 DERIVED

• Fiore M, Adsit R, Zehner M, McCarthy D, Lundsten S, Hartlaub P, Mahr T, Gorrilla A, Skora A, Baker T. An electronic health record-based interoperable eReferral system to enhance smoking Quitline treatment in primary care. J Am Med Inform Assoc. 2019 Aug 1;26(8-9):778-786. doi: 10.1093/jamia/ocz044.

  PMID: 31089727 DERIVED

MeSH Terms

Conditions

Tobacco Use Cessation; Tobacco Smoking; Smoking

Condition Hierarchy (Ancestors)

Health Behavior; Behavior; Tobacco Use

Results Point of Contact

• Title: Mark Zehner, MS
• Organization: Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health

mark.zehner@ctri.wisc.edu

6082627568

Study Officials

• Michael Fiore, MD, MPH, MBA

  University of Wisconsin, Madison

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 1, 2016
• First Posted: April 12, 2016
• Study Start: September 1, 2016
• Primary Completion: March 1, 2018
• Study Completion: April 1, 2018
• Last Updated: September 3, 2019
• Results First Posted: August 13, 2019

Record last verified: 2019-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)