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Clinical Decision Support Tool for Parental Tobacco Treatment in Hospitalized Children
Brian P Jenssen1, Eric D Shelov2, Christopher P Bonafide2
1Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
A new clinical decision support (CDS) tool integrated into electronic health records (EHR) proved feasible and acceptable for pediatric residents to counsel parents on smoking cessation and reduce secondhand smoke (SHS) exposure in children.
Area of Science:
- Pediatric Health
- Clinical Informatics
- Public Health
Background:
- Secondhand smoke (SHS) exposure poses significant health risks to children.
- Pediatricians play a crucial role in addressing parental smoking behaviors.
- Integrating smoking cessation support into routine pediatric care is essential.
Purpose of the Study:
- To develop and assess a clinical decision support (CDS) tool within the electronic health record (EHR).
- To evaluate the feasibility, acceptability, and usability of the CDS tool for pediatric residents.
- To aid pediatricians in providing smoking cessation counseling and treatment to parents of hospitalized children exposed to SHS.
Main Methods:
- A mixed-methods study involving first-year pediatric residents on an inpatient unit.
- Residents received training on smoking cessation, nicotine replacement therapy (NRT), and the CDS tool.
- The CDS tool alerted for SHS exposure, facilitated problem list updates, referred to quitlines, and linked to NRT prescriptions.
Main Results:
- The CDS tool was utilized for 49% of alerted patients, with 39% having SHS exposure added to the problem list.
- 32% of parents were referred to a quitline, and 14% received NRT prescriptions.
- The tool was rated as acceptable and usable by clinicians, with an average System Usability Scale score of 85.
Conclusions:
- A non-interruptive CDS tool integrated into the EHR is feasible, acceptable, and usable for promoting smoking cessation counseling in pediatric settings.
- The tool effectively supports pediatric residents in addressing SHS exposure among hospitalized children's families.
- Further research is warranted to examine the impact of this CDS tool on patient outcomes.
Objectives:
To create and evaluate the feasibility, acceptability, and usability of a clinical decision support (CDS) tool within the electronic health record (EHR) to help pediatricians provide smoking cessation counseling and treatment to parents of hospitalized children exposed to secondhand smoke (SHS).
Methods:
Mixed method study of first-year pediatric residents on one inpatient unit. Residents received training in smoking cessation counseling, nicotine replacement therapy (NRT) prescribing, and use of a CDS tool to aid in this process. The tool, which alerted when a patient was identified as exposed to SHS based on the history taken on admission or during a prior encounter, had the following capabilities: adding SHS exposure to the patient's problem list; referral to Free Quitline through discharge instructions; and linking to a printable NRT prescription form. We measured feasibility by EHR utilization data. We measured acceptability and usability of the tool by administering questionnaires to residents.
Results:
From June-August 2015, the alert triggered for 106 patients, and the tool was used for 52 (49%) patients. 41 (39%) patients had SHS exposure added to the problem list, 34 (32%) parents were referred to the Quitline through discharge instructions, and 15 (14%) parents were prescribed NRT. 10 out of 15 (67%) eligible pediatricians used the tool. All clinicians surveyed (9 out of 10) found the tool acceptable and rated its usability good to excellent (average System Usability Scale score was 85 out of 100, 95% CI, 76-93).
Conclusions:
A non-interruptive CDS tool to help residents provide smoking cessation counseling in the hospital was feasible, acceptable, and usable. Future work will investigate impacts on patient outcomes.
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