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Variation in Patient Smoking Cessation Rates Among Health-Care Providers: An Observational Study.

Abstract：

BACKGROUND:Physicians play a crucial role in providing smoking cessation counseling and medications. However, it is unknown whether individual physicians' approaches affect whether patients quit. RESEARCH QUESTION:This study assessed patient quit rates within a national quality-improvement learning collaborative to document variation in quit rates at the physician, practice, and health system levels. STUDY DESIGN AND METHODS:A retrospective cohort study was conducted of primary care patients identified from the Optum analytics database containing longitudinal ambulatory data for patients from 22 health-care organizations between January 2012 and December 2018. The study included smokers aged ≥ 18 years who attended at least three ambulatory visits, with two visits at least 1 year apart. The primary study outcome was abstinence for ≥ 1 year. A mixed effects logistic regression model was used to predict the probability of quitting as a function of patient variables. Quit rates were then adjusted by patient factors and calculated at the level of clinician, clinic/practice, and health system. RESULTS:Across all systems, 56% of patients had a documented smoking status in 2017. Among nearly 1 million smokers, 24% quit smoking. In the regression model, patient characteristics associated with quitting included older age, Hispanic ethnicity, being married, urban residence, commercial insurance, pregnancy, and a diagnosis of pneumonia, myocardial infarction, ischemic heart disease, cataract, or asthma. Medicaid insurance, low income, high BMI, peripheral vascular disease, alcohol-related diagnosis, and COPD were negatively associated with smoking cessation. Adjusted quit rates ranged from 14.3% to 34.5% across 20 health systems, 5% to 66% among 1,399 practice sites, and 4% to 87% among 3,803 health-care providers. Of smokers, 10.2% were prescribed smoking deterrents, and 3.9% were referred for counseling. INTERPRETATION:Smoking cessation rates varied substantially at the practitioner, practice site, and health system levels. It is likely that individual physician approaches to smoking cessation influence patients' likelihood of quitting.

journal_name

Chest

journal_title

Chest

authors

Almaaitah S,Ciemins EL,Joshi V,Arora A,Meskow C,Rothberg MB

doi

10.1016/j.chest.2020.05.599

subject

Has Abstract

pub_date

2020-11-01 00:00:00

pages

2038-2046

issue

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(20)31682-2

journal_volume

158

pub_type

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Variation in Patient Smoking Cessation Rates Among Health-Care Providers: An Observational Study.