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Improving Tobacco Cessation Rates Using Inline Clinical Decision Support.

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A clinical decision support (CDS) tool significantly increased tobacco cessation rates among users by prompting clinicians. This quality improvement project highlights the effectiveness of user-centered design in public health interventions.

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Area of Science:

  • Public Health
  • Health Informatics
  • Clinical Interventions

Background:

  • Tobacco use remains a leading cause of preventable death and disease in the U.S.
  • Clinician-provided advice is effective for tobacco cessation, yet often underutilized.
  • Opportunities for brief tobacco cessation interventions are frequently missed in clinical settings.

Purpose of the Study:

  • To enhance tobacco cessation rates among tobacco users through a quality improvement initiative.
  • To implement and evaluate a clinical decision support (CDS) tool designed to prompt clinicians.
  • To leverage user-centered design principles for effective clinical intervention.

Main Methods:

  • Developed a CDS tool integrating user-centered design and the CDS Five Rights.
  • Dynamically inserted tobacco user information into clinician notes (Assessment and Plan).
  • Conducted a retrospective analysis at four primary care practices, using Cox proportional-hazards models and Kaplan-Meier curves to assess time to cessation.

Main Results:

  • Analyzed 5,644 patients; median age 45, 60% male, 99.5% urban.
  • Intervention group showed a significantly higher risk of tobacco cessation (HR: 1.22, 95% CI: 1.08-1.36, p=0.001) after adjustments.
  • Median follow-up was 16 months, with cessation probabilities estimated at 90, 180, and 365 days.

Conclusions:

  • A CDS intervention, adhering to the CDS Five Rights and user-centered design, can positively impact tobacco use rates.
  • The study demonstrates the potential of technology-driven nudges in improving public health outcomes.
  • Future research should broaden the CDS tool's reach and continue iterative, user-focused development.