Electronic health records as a tool for recruitment of participants' clinical effectiveness research: lessons learned from tobacco cessation

ABSTRACTTranslating tobacco dependence treatments that are effective in research settings into real-world clinical settings remains challenging. Electronic health record (EHR) technology can facilitate this process. This paper describes the accomplishments and lessons learned from a translational team science (clinic/research) approach to the development of an EHR tool for participant recruitment and clinic engagement in tobacco cessation research. All team stakeholders—research, clinical, and IT—were engaged in the design and planning of the project. Results over the first 17 months of the study showed that over one half of all smokers, coming in for any type of clinic appointment, were offered participation in the study, a very high level of adherent use of the EHR. Study recruitment over this period was 1,071 individuals, over 12 % of smokers in the participating clinics.

[1]  N. Sharpe.  Clinical Trials and the Real World: Selection Bias and Generalisability of Trial Results , 2004, Cardiovascular Drugs and Therapy.

[2]  S. Moore.  A need to try everything: patient participation in phase I trials. , 2001, Journal of advanced nursing.

[3]  R. Hornung,et al.  Effect of a clinical trial alert system on physician participation in trial recruitment. , 2005, Archives of internal medicine.

[4]  Stuart Speedie,et al.  The Electronic Primary Care Research Network (ePCRN): a new era in practice-based research. , 2006, Journal of the American Board of Family Medicine : JABFM.

[5]  C. Coltman,et al.  Underrepresentation of patients 65 years of age or older in cancer-treatment trials. , 1999, The New England journal of medicine.

[6]  T. Bodenheimer,et al.  Practice-Based Research in Primary Care: Facilitator of, or Barrier to, Practice Improvement? , 2005, The Annals of Family Medicine.

[7]  Chun-Ju Hsiao,et al.  Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates , 2010 .

[8]  Megan E. Piper,et al.  The Multiphase Optimization Strategy for Engineering Effective Tobacco Use Interventions , 2011, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[9]  Gary S. Fischer,et al.  Comparison of Electronic Physician Prompts versus Waitroom Case-Finding on Clinical Trial Enrollment , 2008, Journal of General Internal Medicine.

[10]  Terhilda Garrido,et al.  Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study , 2005, BMJ : British Medical Journal.

[11]  D. Blumenthal.  Barriers to the Provision of Smoking Cessation Services Reported by Clinicians in Underserved Communities , 2007, The Journal of the American Board of Family Medicine.

[12]  J. Ockene,et al.  Translating Efficacy Research to Effectiveness Studies in Practice: Lessons From Research to Promote Smoking Cessation in Community Health Centers , 2004, Health promotion practice.

[13]  Liam Glynn,et al.  Selection bias resulting from the requirement for prior consent in observational research: a community cohort of people with ischaemic heart disease , 2007, Heart.

[14]  Philip A. Bain,et al.  A demonstration project for using the electronic health record to identify and treat tobacco users. , 2010, WMJ : official publication of the State Medical Society of Wisconsin.

[15]  D. Singer,et al.  National patterns in the treatment of smokers by physicians. , 1998, JAMA.

[16]  Joseph Siemienczuk,et al.  Provider feedback to improve 5A's tobacco cessation in primary care: a cluster randomized clinical trial. , 2007, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[17]  M. Munafo,et al.  Weekly versus basic smoking cessation support in primary care: a randomised controlled trial , 2007, Thorax.

[18]  Erin M. Goldblatt,et al.  From bench to bedside: the growing use of translational research in cancer medicine. , 2010, American journal of translational research.

[19]  Amardeep Thind,et al.  Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records) and health administrative data: a retrospective cohort study , 2010, BMC health services research.

[20]  C. T. Orleans,et al.  Evaluating primary care behavioral counseling interventions: an evidence-based approach. , 2002, American journal of preventive medicine.

[21]  Megan E. Piper,et al.  New Methods for Tobacco Dependence Treatment Research , 2011, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[22]  M. Fiore.  The new vital sign. Assessing and documenting smoking status. , 1991, JAMA.

[23]  V W Berger,et al.  Detecting selection bias in randomized clinical trials. , 1999, Controlled clinical trials.

[24]  Robert Unitan,et al.  Improving population care with an integrated electronic panel support tool. , 2011, Population health management.

[25]  Á. Helgason,et al.  General practitioners' perceived barriers to smoking cessation - results from four Nordic countries , 2002, Scandinavian journal of public health.

[26]  Jeffrey A. Linder,et al.  Using Electronic Health Records to Measure Physician Performance for Acute Conditions in Primary Care: Empirical Evaluation of the Community-Acquired Pneumonia Clinical Quality Measure Set , 2009, Medical care.

[27]  L. Kuller,et al.  Selection Bias and Nonresponse to Health Promotion in Older Adults , 1994, Epidemiology.

[28]  A. Goldstein,et al.  Smoking As a Vital Sign: Prompts to Ask and Assess Increase Cessation Counseling , 2009, The Journal of the American Board of Family Medicine.

[29]  Gunjan Sinha,et al.  Electronic health records help recruit trial participants and track drug safety. , 2008, Journal of the National Cancer Institute.

[30]  Raymond Boyle,et al.  Use of electronic health records to support smoking cessation. , 2014, The Cochrane database of systematic reviews.

[31]  Jerry L Miller,et al.  The EHR solution to clinical trial recruitment in physician groups. , 2006, Health management technology.

[32]  C. Lenfant.  Shattuck lecture--clinical research to clinical practice--lost in translation? , 2003, The New England journal of medicine.

[33]  V. Stone,et al.  Race, gender, drug use, and participation in AIDS clinical trials. Lessons from a municipal hospital cohort. , 1997, Journal of general internal medicine.

[34]  Tobacco Use and Dependence Guideline Panel.  Treating Tobacco Use and Dependence: 2008 Update , 2008 .

[35]  D. O'donoghue,et al.  Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of healthcare , 2010, Quality and Safety in Health Care.

[36]  R. Richmond,et al.  Role of the general practitioner in smoking cessation. , 2006, Drug and alcohol review.

[37]  E. Yano,et al.  Targeting primary care referrals to smoking cessation clinics does not improve quit rates: implementing evidence-based interventions into practice. , 2008, Health services research.

[38]  M. Burnam.  Measuring outcomes of care for substance use and mental disorders. , 1996, New directions for mental health services.

[39]  M. Munafo,et al.  A Randomised Control Led Trial of Weekly versus Basic Smoking Cessation Support in Primary Care , 2007 .

[40]  M. Fiore,et al.  Treating tobacco use and dependence: an evidence-based clinical practice guideline for tobacco cessation. , 2002, Chest.

[41]  F. Nieman,et al.  Determinants of patient participation in clinical studies requiring informed consent: why patients enter a clinical trial. , 1998, Patient education and counseling.

[42]  S. Straus,et al.  Learning in practice The case for knowledge translation : shortening the journey from evidence to effect , 2003 .

[43]  Lynne S Nemeth,et al.  Improving Medication Safety in Primary Care Using Electronic Health Records , 2010, Journal of patient safety.

[44]  D. Conwill,et al.  The new vital sign. , 1992, JAMA.

[45]  Richard L Berg,et al.  Use of an Electronic Medical Record for the Identification of Research Subjects with Diabetes Mellitus , 2007, Clinical Medicine & Research.

[46]  Chunhua Weng,et al.  Using Personal Health Records for Automated Clinical Trials Recruitment: the ePaIRing Model , 2009, Summit on translational bioinformatics.

[47]  C. Goss,et al.  Clinical trial participants compared with nonparticipants in cystic fibrosis. , 2006, American journal of respiratory and critical care medicine.