Trends in smoking documentation rates in safety net clinics.

Abstract

To assess the impact of provider incentive policy on smoking status documentation. Primary data were extracted from structured electronic medical records (EMRs) from 15 community health centers (CHCs). This was an observational study of data from 2006 to 2013, assessing changes in documentation of smoking status over time. We extracted structured EMR data for patients age 18 and older with at least one primary care visit. Rates of documented smoking status rose from 30 percent in 2006 to 90 percent in 2013; the largest increase occurred from 2011 to 2012 following policy changes (21.3% [95% CI, 8.2%, 34.4%] from the overall trend). Rates varied by clinic and across patient subgroups. Documentation of smoking status improved markedly after introduction of new federal standards. Further improvement in documentation is still needed, especially for males, nonwhite patients, those using opioids, and HIV+patients. More research is needed to study whether changes in documentation lead to improvements in counseling, cessation, and patient outcomes.