October 28, 2025
3 min read
Key takeaways:
- Tobacco treatment reach and smoking cessation rates were collected before and after implementation of a point-of-care tobacco treatment program.
- Outcomes improved after implementation.
CHICAGO — A tobacco treatment program included in electronic health records significantly raised treatment reach and the percentage of patients who achieved smoking abstinence, according to data presented at the CHEST Annual Meeting.
“This is a low burden intervention that did not require any additional hiring of staff,” Alexandra Khodadadi, MD, MSPH, pulmonary and critical care medicine fellow physician at Washington University, said during her presentation. “It was scaled to about 100 clinics within the department of medicine within our health system and was found to have an increase in both reach and effectiveness.”
Data were derived from Khodadadi A, et al. Lessons from a learning health system: Closing the implementation gap with a point of care tobacco treatment model in an academic medical center. Presented at: CHEST Annual Meeting; Oct. 19-22, 2025; Chicago.
In this study, Khodadadi and colleagues assessed patient encounters at Washington University School of Medicine clinics from 6 months before and 6 months after implementation of the point-of-care Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment (ELEVATE) program to determine how it impacts tobacco treatment reach and smoking cessation rates.
“There’s established guidelines for smoking cessation management that recommend a combination of pharmacotherapy and behavioral counseling,” Khodadadi said. “However, the CDC Morbidity and Mortality Report estimated that only about 38% of patients report using either counseling or medication when trying to quit smoking.
“Multiple barriers have been identified that contribute to this underutilization at various levels within the health care system,” she continued. “Some examples include repeat clinic visits for patients, provider lack of time or budget constraints and staff turnover at the system level. A point-of-care model for smoking cessation management provides an opportunity to relieve these barriers.”
Notably, ELEVATE is utilized by medical assistants, who are prompted to ask patients about smoking status during their clinic visit. If the patient is a current smoker, medical assistants are advised to carry out some actions.
“All those patients will receive brief, scripted advice by the medical assistant, and then, through the electronic health record, they’re able to provide counseling options and referrals to counseling to either a phone, text or app-based quit line,” Khodadadi said.
Khodadadi highlighted that the medical assistant places the order, and the clinician can cosign it.
“The order will directly contact the quit line for the patient’s respective state, and they will be contacted by the quit line, so the patient doesn’t have to do that on their own,” she said.
The before implementation period included 106,911 unique patient encounters (59.8% female; 80% white; 98.2% non-Hispanic), and during this 6-month timeframe, the smoking prevalence was 10.1%. Khodadadi noted that this prevalence varied across subspecialities, with the lowest prevalence in geriatrics (3.7%) and the highest prevalence in infectious diseases (23.9%).
Among the included subspeciality clinics, those with the highest rate of tobacco treatment reach before implementation were pulmonary clinics (42.6%), according to the presentation.
The after implementation period included 110,882 unique patient encounters (60.9% female; 80.5% white; 98.2% non-Hispanic), and during this 6-month period, the smoking prevalence was 10.4%. Khodadadi again said the prevalence varied across subspecialties, with the lowest in geriatrics and the highest in infectious diseases.
Using a multivariable generalized estimating equation model, researchers observed a rise in the percentage of patients receiving tobacco treatment (reach) from before to after ELEVATE implementation by nearly 9% (20.9% to 29.7%). Similarly, the likelihood for treatment reach was significantly higher after vs. before implementation when controlling for demographics, comorbidities and different subspecialty clinics (OR = 1.39; 95% CI, 1.31-1.47).
The percentage of patients who achieved smoking abstinence was also higher after vs. before implementation (15.9% vs. 11.9%), and the odds for this outcome were significantly higher after vs. before implementation in the adjusted analysis (OR = 1.29; 95% CI, 1.21-1.37), according to the presentation.
Researchers further found that more patients quit smoking if they did vs. did not receive any tobacco treatment after ELEVATE implementation (32.7% vs. 8.8%). In the adjusted analysis, treated vs. untreated patients had a significantly greater likelihood of quitting (OR = 5.03; 95% CI, 4.51-5.61).
“Tobacco treatment does continue to remain low with the post-ELEVATE implementation period reach being around 30%, which does provide an opportunity for future studies to focus on optimizing the implementation of this model,” Khodadadi said.
“I’m personally working on a mixed methods needs assessment within the pulmonary subspecialty clinics to identify facilitators and barriers to implementing this model,” she continued.
Sources/Disclosures
Source:
Khodadadi A, et al. Lessons from a learning health system: Closing the implementation gap with a point of care tobacco treatment model in an academic medical center. Presented at: CHEST Annual Meeting; Oct. 19-22, 2025; Chicago.
Disclosures:
Khodadadi reports no relevant financial disclosures.
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