UT MD Anderson study shows new approach connecting smokers to quit lines increases smoking cessation treatment enrollment

Targeted intervention in health care settings may reduce tobacco-related illness and death

MD Anderson News Release 02/25/13

Self-identified smokers directly connected to a tobacco cessation quit line are 13 times more likely to enroll in a treatment program as compared to smokers who are handed a quit line referral card and encouraged to call on their own, according to a new study published online in JAMA Internal Medicine.

Led by researchers at The University of Texas MD Anderson Cancer Center, the study evaluated the efficacy of an "Ask-Advise-Connect" approach to linking smokers to evidence-based tobacco cessation treatment. The approach is based on the current recommended standard of care in the field, as described in the Treating Tobacco Use and Dependence Clinical Practice Guideline.

Ask-Advise-Connect, MD Anderson's collaborative study with the Texas Quitline and Kelsey-Seybold Clinic - Houston's largest community-based physician group and private health care system -streamlined and automated the process of connecting smokers with treatment using their electronic health record (EHR).

"Approximately 70 percent of smokers see their primary care physician at least once a year, so health care settings provide an ideal infrastructure for linking smokers with cessation treatment," said Jennifer Irvin Vidrine, Ph.D., associate professor in the Department of Health Disparities Research at MD Anderson and lead investigator on the study.

In this study, licensed vocational nurses and medical assistants were trained to ask all patients about their smoking status at the time vital signs were collected, and to record this information in the EHR. Smokers were also given advice on quitting and offered either a connection or referral to the quit line, depending on clinic randomization.

Ten clinics participated in the study with five clinics randomized to implement Ask-Advise-Connect, and the others randomized to implement a control condition called Ask-Advise-Refer. The process was the same in both clinic settings except for the method used to link smokers with the quit line.

In Ask-Advise-Connect clinics, contact information for patients willing to be connected to the quit line was pulled directly from the EHR and sent to the MD Anderson research team. The information was then sent to the Texas Quitline within 24 hours, and patients were called by quit line staff within 48 hours of receiving their information.

In Ask-Advise-Refer clinics, the names and phone numbers of patients willing to accept a referral card were sent to the MD Anderson research team. Patients were encouraged to call the quit line on their own, and patients who called were tracked by quit line staff. Both approaches were implemented for nine months.

The smoking status of more than 32,000 patients was assessed and recorded in the EHR, and 3,336 patients reported current smoking, a smoking prevalence of 11.2 percent.

The study's primary outcome was impact, defined as the proportion of all identified smokers who enrolled in smoking cessation treatment with the quit line," said Vidrine.  

The results indicated that 7.8 percent of all smokers identified at Ask-Advise-Connect clinics enrolled in treatment with the quit line compared to 0.6% of all smokers identified at Ask-Advise-Refer clinics, reflecting a 13-fold increase in treatment enrollment.

"The findings reflect one of the highest rates of tobacco cessation treatment enrollment reported in the literature to-date," said Vidrine. "Given that smoking is the leading cause of preventable morbidity and mortality in the U.S., Ask-Advise-Connect has tremendous potential to have a large public health impact if adopted broadly by other health care systems.