An EHR-automated and theory-based population health management intervention for smoking cessation in diverse low-income patients of safety-net health centers: a pilot randomized controlled trial

Brian Hitsman*, Phoenix A. Matthews, George D. Papandonatos, Kenzie A. Cameron, Sarah S. Rittner, Nivedita Mohanty, Timothy Long, Ronald T. Ackermann, Edgardo Ramirez, Jeremy Carr, Emmanuel Cordova, Cherylee Bridges, Crystal Flowers-Carson, Aida Luz Giachello, Andrew Hamilton, Christina C. Ciecierski, Melissa A. Simon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

This study tested the preliminary effectiveness of an electronic health record (EHR)-automated population health management (PHM) intervention for smoking cessation among adult patients of a federally qualified health center in Chicago. Participants (N = 190; 64.7% women, 82.1% African American/Black, 8.4% Hispanic/Latino) were self-identified as smokers, as documented in the EHR, who completed the baseline survey of a longitudinal "needs assessment of health behaviors to strengthen health programs and services."Four weeks later, participants were randomly assigned to the PHM intervention (N = 97) or enhanced usual care (EUC; N = 93). PHM participants were mailed a single-page self-determination theory (SDT)-informed letter that encouraged smoking cessation or reduction as an initial step. The letter also addressed low health literacy and low income. PHM participants also received automated text messages on days 1, 5, 8, 11, and 20 after the mailed letter. Two weeks after mailing, participants were called by the Illinois Tobacco Quitline. EUC participants were e-referred following a usual practice. Participants reached by the quitline were offered behavioral counseling and nicotine replacement therapy. Outcome assessments were conducted at weeks 6, 14, and 28 after the mailed letter. Primary outcomes were treatment engagement, utilization, and self-reported smoking cessation. In the PHM arm, 25.8% of participants engaged in treatment, 21.6% used treatment, and 16.3% were abstinent at 28 weeks. This contrasts with no quitline engagement among EUC participants, and a 6.4% abstinence rate. A PHM approach that can reach all patients who smoke and address unique barriers for low-income individuals may be a critical supplement to clinic-based care.

Original languageEnglish (US)
Pages (from-to)892-899
Number of pages8
JournalTranslational behavioral medicine
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2022

Keywords

  • Electronic health record system
  • Low income
  • Population health management
  • Quitline
  • Smoking cessation
  • Treatment engagement

ASJC Scopus subject areas

  • Behavioral Neuroscience
  • Applied Psychology

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