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Design and Pilot Implementation of an Electronic Health Record-Based System to Automatically Refer Cancer Patients to Tobacco Use Treatment
Open AccessArticle

An Evaluation of the Process and Quality Improvement Measures of the University of Virginia Cancer Center Tobacco Treatment Program

1
Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
2
Cancer Center, University of Virginia, Charlottesville, VA 22908, USA
3
Center for Addiction Prevention Research, University of Virginia, Charlottesville, VA 22908, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(13), 4707; https://doi.org/10.3390/ijerph17134707
Received: 31 May 2020 / Revised: 22 June 2020 / Accepted: 25 June 2020 / Published: 30 June 2020
(This article belongs to the Special Issue Tobacco Use and Treatment among Cancer Survivors)
Tobacco use after a cancer diagnosis can increase risk of disease recurrence, increase the likelihood of a second primary cancer, and negatively impact treatment efficacy. The implementation of system-wide comprehensive tobacco cessation in the oncology setting has historically been low, with over half of cancer clinicians reporting that they do not treat or provide a referral to cessation resources. This quality improvement study evaluated the procedures for assessing and documenting tobacco use among cancer survivors and referring current smokers to cessation resources at the University of Virginia Cancer Center. Process mapping revealed 20 gaps across two major domains: electronic health record (EHR), and personnel barriers. The top identified priority was inconsistent documentation of tobacco use status as it impacted several downstream gaps. Eleven of the 20 gaps were deemed a high priority, and all were addressed during the implementation of the resulting Tobacco Treatment Program. Prioritized gaps were addressed using a combination of provider training, modifications to clinical workflow, and EHR modifications. Since implementation of solutions, the number of unique survivors receiving cessation treatment has increased from 284 survivors receiving cessation support during Year 1 of the initiative to 487 in Year 3. The resulting Tobacco Treatment Program provides a systematic, personalized, and sustainable comprehensive cessation program that optimizes the multifaceted workflow of the Cancer Center and has the potential to reduce tobacco use in a population most in need of cessation support. View Full-Text
Keywords: Cancer survivorship; smoking cessation; quality improvement; process mapping Cancer survivorship; smoking cessation; quality improvement; process mapping
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Wiseman, K.P.; Hauser, L.; Clark, C.; Odumosu, O.; Dahl, N.; Peregoy, J.; Sheffield, C.W.; Klesges, R.C.; Anderson, R.T. An Evaluation of the Process and Quality Improvement Measures of the University of Virginia Cancer Center Tobacco Treatment Program. Int. J. Environ. Res. Public Health 2020, 17, 4707.

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