Project 1: Evaluating EHR-Based Health System Modifications for the Chronic Care of Smoking

Specifically, this Project will develop and test new EHR enhancements and associated
healthcare practices that are designed to efficiently identify smokers and recruit them into
a chronic care treatment for smoking (which will be developed and evaluated in Projects 2-4).
The EHR enhancements will include: 1) smoker identification and documentation aids, 2) a
"Smoker Registry" (which stores relevant data on smokers and facilitates tracking their
smoking status over time), 3) a 1-click system to refer smokers to the chronic care treatment
for smoking, 4) a closed-loop function to provide EHR feedback to clinicians on the outcomes
of their referrals, and 5) communications resources to inform smokers of treatment options
and to increase their recruitment into treatment. The effects of the EHR-based enhancements
and the chronic care smoking treatment will be evaluated with a multiple baseline design
involving 18 primary care clinics in three healthcare systems in Wisconsin; all participants
for affiliated clinical research Projects will be recruited from these clinics. This highly
innovative research will evaluate the impact of an integrated set of EHR enhancements—coupled
with a chronic care approach to smoking treatment—on smoker identification, and smoking
treatment referral and engagement. In addition, this research will explore factors that
influence the use of EHR-based enhancements in clinics. In sum, this research will develop a
set of EHR-based health system enhancements that increase both the adoption of chronic care
treatment by healthcare systems and smokers' engagement in that treatment.

Inclusion Criteria:

- The clinics participating in the MBD experiment will be selected based on the
following criteria:

1. Size: clinics will be fairly large, including at least 4-6 clinicians, to ensure
adequate recruitment for clinical trials connected with thye EHR recruitment.

2. Location: clinics will be concentrated in Southcentral and Southeastern Wisconsin
so that case managers from UW-CTRI Madison and Milwaukee research sites can
provide services at multiple clinics.

3. Diversity: clinics from each of the two health systems will include both urban
and rural locations, and at least one high- and one low-SES clinic (based on
rates of Medicaid and uninsured patients).

4. Independence: clinics will not share staff or be physically adjacent to one
another to combat bleeding of interventions across clinics (see 87 for the
independence requirement for MBD).

5. All clinics will routinely collect the data that will serve as dependent
variables in the MBD design (this will be universal among the three health system
clinics).

Exclusion Criteria:

- Any clinic not meeting the above inclusion criteria