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Tools to Improve Documentation of Smoking Status
Continuous Quality Improvement and Electronic Medical Records
Elizabeth Spencer, RD, MS;
Todd Swanson, MD;
William J. Hueston, MD;
Debora L. Edberg, LPN
Arch Fam Med. 1999;8:18-22.
Background Despite the deleterious effects of smoking on the nation's health and evidence that smoking cessation advice by family practice physicians is cost-effective, self-sustaining office systems to identify smokers in primary care clinics have been difficult to establish. We worked on a continuous quality improvement project group, aided by an electronic medical record, to design a system to document and periodically update smoking status in a consistent place in the medical record.
Intervention Using the continuous quality improvement plan-do-study-act cycle, a 7-member group worked with nursing staff to define roles, routines, and responsibilities for medical assistants to screen for and document 1 of 4 categories of smoking status in the major problem list of the electronic medical record for at least 80% of patient appointments. Screening rate was tracked monthly by means of the electronic medical record and feedback was given to staff.
Results The screening rate rose from 18.4% to 80.3% within 2 weeks after the system was implemented and was maintained for 19 months. An additional benefit was an increased rate of smoking cessation counseling documented by providers, from a baseline rate of 17.1% to 48.3%.
Conclusions A continuous quality improvement group process aided by an electronic medical record is useful to develop a self-sustaining office system to screen, document, and periodically update smoking status in a consistent place in the medical record. Although screening for and documenting smoking status are only the first step toward helping patients stop smoking, it is an important one.
From the Eau Claire Family Practice Residency Program, Department of Family Medicine, University of Wisconsin–Madison (Mss Spencer and Edberg); the Boise Family Practice Residency, Boise, Idaho (Dr Swanson); and the Department of Family Medicine, Medical Unviersity of South Carolina (Dr Hueston).
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