Vaping: Impact of Improving Screening Questioning in Adolescent Population: A Quality Improvement Initiative

Area of Science:

• Public Health
• Adolescent Medicine
• Healthcare Quality Improvement

Background:

• Electronic Nicotine Delivery Systems (ENDS) are the most common tobacco product among youth.
• Physician screening for tobacco use is common, but screening for ENDS use is infrequent.
• This project addresses the need to improve ENDS screening in adolescent healthcare settings.

Purpose of the Study:

• To increase the screening rate of ENDS use among adolescents to 85%.
• To align with the Healthy People 2020 screening target for traditional smoking.
• To evaluate the effectiveness of quality improvement interventions on ENDS screening.

Main Methods:

• Data collected via weekly chart reviews of adolescent primary care visits.
• Utilized keywords like "vapor," "e-cigs," and "vaping" to identify screening documentation.
• Implemented four Plan-Do-Study-Act (PDSA) cycles, including staff education and EHR modification.

Main Results:

• Screening for traditional tobacco use remained higher than for ENDS use.
• Adolescent ENDS use assessment increased from 0% at baseline to 90% post-intervention.
• Adding a specific ENDS screening question to the Electronic Health Record (EHR) significantly improved screening rates to 78%.

Conclusions:

• A general "do you smoke?" question is insufficient for assessing ENDS use.
• Direct questioning is necessary for adequate ENDS use assessment in adolescents.
• Integrating specific ENDS screening questions into the EHR is the most effective method to increase screening rates.