Effectiveness of an Opt-Out Electronic-Heath Record-based Tobacco Treatment Consult Service at an Urban Safety-Net Hospital

Abstract Background To address the burden of tobacco use in underserved populations, our safety-net hospital developed a tobacco treatment intervention consisting of an "opt-out" Electronic Health Record (EHR)-based Best Practice Alert (BPA)+order-set, which triggers consultation to an inpatient Tobacco Treatment Consult (TTC) service for all hospitalized smokers. Research Question We sought to understand if the intervention would increase patient-level outcomes (receipt of tobacco treatment during hospitalization and at discharge; 6-month smoking abstinence), and improve hospital-wide performance on tobacco treatment metrics. Study Design and Methods: We conducted two retrospective quasi-experimental analyses to examine effectiveness of the TTC service. Using a pragmatic design and multivariable logistic regression, we compared patient-level outcomes of receipt of nicotine replacement therapy and 6-month quit rates between smokers seen by the service (n=505) and eligible smokers not seen due to time constraints (n=680) between July 2016-December 2016. In addition, we conducted an interrupted time series analysis to examine the effect of the TTC service on hospital-level performance measures, comparing reported Joint Commission measure rates for inpatient (Tob-2) and post-discharge (Tob-3) tobacco treatment pre- (January 2015-June 2016) versus post- (July 2016-December 2017) implementation of the intervention. Results Compared to inpatient smokers not seen by the TTC service, smokers seen by the TTC service had higher odds of receiving nicotine replacement during hospitalization (51.5% [260/505] vs 35.9% [244/680], adjusted odds ratios (AOR)=1.93 [95% CI 1.5-2.45]) and at discharge (32.5% [164/505] vs 12.4% [84/680], AOR=3.41 [2.54-4.61]), as well as higher odds of 6-month smoking abstinence (14.9% (75/505) vs 10% (68/680), AOR=1.48 [1.03-2.12]). Hospital-wide, the intervention was associated with a change in slope trends for Tob-3 (p Interpretation The "opt-out" EHR-based TTC service at our large safety-net hospital was effective at improving both patient-level outcomes and hospital-level performance metrics, and could be implemented at other safety net hospitals that care for hard-to-reach smokers.