Trial Information

Using Electronic Medical Records to Measure and Improve Adherence to Tobacco Treatment Guidelines in Primary Care

OBJECTIVES:

- Develop an automated coding system using existing electronic medical records (EMRs) to
assess adherence to national tobacco-cessation treatment guidelines by individual
physicians in the primary care setting at 4 health maintenance organizations.

- Compare the validity of the automated coding system with that of coding performed by
medical record abstractors.

- Determine the effect of performance feedback on tobacco treatment practice patterns
over 2 years among primary care physicians.

- Provide recommendations for recording tobacco-cessation treatment services in EMR
systems and evaluating adherence to treatment guidelines.

- Produce a set of computer programs that can be easily adopted in diverse health care
settings for assessing adherence to the national tobacco-cessation treatment guidelines
using data from EMRs.

OUTLINE: This is a randomized, controlled, multicenter study. Physicians from each
participating center are sorted into pairs according to their rate of providing advice to
quit smoking to identified adult smokers and the number of identified adult smokers seen in
the 3-month baseline observation period. Each physician in the pair is then randomized to 1
of 2 arms.

- Arm I (automated coding system feedback): Physicians receive reports from an automated
coding system regarding their performance in administering tobacco-cessation services
in each of the five A's (Ask, Advise, Assess, Assist, and Arrange) to identified
smokers in comparison with their past performance and in comparison with their
anonymous colleagues once every 3 months. One year after randomization, these
physicians are further randomized, using the same paired-group approach, to either
continue receiving automated coding system feedback for 1 additional year OR to stop
receiving feedback.

Physicians receive a survey at the end of 2-year period regarding the usefulness of each
aspect of the feedback reports and the feedback program in general.

- Arm II (control): Physicians do not receive any information regarding their performance
in administering tobacco-cessation services in each of the five A's to identified
smokers.

A questionnaire about tobacco-cessation services in primary care is sent to patients of all
physicians within two weeks of each patient's primary care visit and then at the end of the
first year of providing feedback to physicians to compare patient report of
tobacco-cessation services with what is documented in the electronic medical record for that
primary care visit.

PROJECTED ACCRUAL: At least 40 primary care physicians per participating center and 1,000
patients (250 per participating center) will be accrued for this study.