Tools to improve documentation of smoking status - Continuous quality improvement and electronic medical records

Background: Despite the deleterious effects of smoking on the nation's heal th and evidence that smoking cessation advice by family practice physicians is cost-effective, self-sustaining office systems to identify smokers in p rimary care clinics have been difficult to establish. We worked on a contin uous quality improvement project group, aided by an electronic medical reco rd, to design a system to document and periodically update smoking status i n a consistent place in the medical record. Intervention: Using the continuous quality improvement plan-do-study-act cy cle, 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 wa s tracked monthly by means of the electronic medical record and feedback wa s given to staff. Results: The screening rate rose from 18.4% to 80.3% within 2 weeks after t he system was implemented and was maintained for 19 months. An additional b enefit was an increased rate of smelting 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 ele ctronic medical record is useful to develop a self-sustaining office system to screen, document, and periodically update smelting status in a consiste nt place in the medical record. Although screening for and documenting smok ing status are only the first step toward helping patients stop smoking, it is an important one.