Trial Outcomes & Findings for An EPIC Based BPA to Enhance Quit Line Referral and Use (NCT NCT03229356)

Results Overview

Number of referrals made out of total eligible for referral.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

22 participants

Primary outcome timeframe

6 months

Results posted on

2023-11-18

Participant Flow

Waitlist Control Sites A and B were together (8) in the first 6 months after which they were randomized to A (4) and B (4).

Unit of analysis: Practice Sites

Participant milestones

Participant milestones
Measure	Waitlist Control - A BPA+ Enhanced Education will be rolled out to waitlist control sites after 6 months.	Waitlist Control - B BPA will be rolled out to waitlist control sites after 6 months.	Best Practices Advisory (BPA) Clinicians will receive an email describing the BPA and order set, along with internet links to MD Quit Line without additional supplemental education. Best Practices Advisory (BPA): 1. BPA: The BPA is an Epic prompt that fires when a provider opens an encounter with a patient who is actively smoking. Providers will be asked to assess smoking cessation readiness and to refer patients to the free Maryland Quit Line if the patient is receptive. The Quit Line will receive an electronic referral with the patient's details. A Quit Line certified smoking cessation counselor will then call the patient at a later date and provide counseling. Receptive patient will receive up to four calls. They will receive counseling from a trained quit coach and be offered free access to NRT. 2\. Quit Line: This free telephone-based counseling service is offered to smoker in Maryland. Services offered include on-the-phone smoking cessation counseling and free nicotine replacement.	BPA+ Enhanced Education Clinicians will receive an email describing the new smoking BPA, educational materials offered, and a small tutorial on using the BPA and a new smoking cessation smart set in Epic. Education materials will include the educational hand out and academic detailing from Maryland Quit Line counselors. BPA + Enhanced Education: BPA with Quitline Referral plus 1)Consolidated educational hand out: The hand out will include a information about counseling, pharmacotherapy, and cessation referrals 2)Online modules: Providers will be directed to optional, self-paced educational modules through the Maryland HABITS program 3)Academic detailing: This will include a single session during a clinic day in which counseling experts from the MD Quit Line will visit providers in their practice setting.
Phase 1 (Months 1-6) STARTED	0 4	0 4	0 7	0 7
Phase 1 (Months 1-6) COMPLETED	0 4	0 4	0 7	0 7
Phase 1 (Months 1-6) NOT COMPLETED	0 0	0 0	0 0	0 0
Phase 2 (Months 7-12) STARTED	0 4	0 4	0 7	0 7
Phase 2 (Months 7-12) COMPLETED	0 4	0 4	0 7	0 7
Phase 2 (Months 7-12) NOT COMPLETED	0 0	0 0	0 0	0 0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

An EPIC Based BPA to Enhance Quit Line Referral and Use

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Waitlist Control - A n=4 Practice Sites BPA+ Enhanced Education will be rolled out to waitlist control sites after 6 months.	Waitlist Control - B n=4 Practice Sites BPA will be rolled out to waitlist control sites after 6 months.	Best Practices Advisory (BPA) n=7 Practice Sites Clinicians will receive an email describing the BPA and order set, along with internet links to MD Quit Line without additional supplemental education. Best Practices Advisory (BPA): 1. BPA: The BPA is an Epic prompt that fires when a provider opens an encounter with a patient who is actively smoking. Providers will be asked to assess smoking cessation readiness and to refer patients to the free Maryland Quit Line if the patient is receptive. The Quit Line will receive an electronic referral with the patient's details. A Quit Line certified smoking cessation counselor will then call the patient at a later date and provide counseling. Receptive patient will receive up to four calls. They will receive counseling from a trained quit coach and be offered free access to NRT. 2\. Quit Line: This free telephone-based counseling service is offered to smoker in Maryland. Services offered include on-the-phone smoking cessation counseling and free nicotine replacement.	BPA+ Enhanced Education n=7 Practice Sites Clinicians will receive an email describing the new smoking BPA, educational materials offered, and a small tutorial on using the BPA and a new smoking cessation smart set in Epic. Education materials will include the educational hand out and academic detailing from Maryland Quit Line counselors. BPA + Enhanced Education: BPA with Quitline Referral plus 1)Consolidated educational hand out: The hand out will include a information about counseling, pharmacotherapy, and cessation referrals 2)Online modules: Providers will be directed to optional, self-paced educational modules through the Maryland HABITS program 3)Academic detailing: This will include a single session during a clinic day in which counseling experts from the MD Quit Line will visit providers in their practice setting.	Total n=22 Practice Sites Total of all reporting groups
Region of Enrollment United States	4 Practice Sites n=4 Practice Sites	4 Practice Sites n=4 Practice Sites	7 Practice Sites n=7 Practice Sites	7 Practice Sites n=7 Practice Sites	22 Practice Sites n=22 Practice Sites

PRIMARY outcome

Timeframe: 6 months

Population: This assessment was on number of service referrals made out of eligible encounters and not individual participants. Individual participants analyzed was not collected. Referrals were not made for Waitlist control groups A and B because they were not randomized yet at this time to either BPA or BPA+ Enhanced Education. Data not collected from the waitlist groups at this time point as the intervention had not been rolled out.

Number of referrals made out of total eligible for referral.

Outcome measures

Outcome measures
Measure	Waitlist Control - A BPA+ Enhanced Education will be rolled out to waitlist control sites after 6 months.	Waitlist Control - B BPA will be rolled out to waitlist control sites after 6 months.	Best Practices Advisory (BPA) n=6857 Eligible Encounters Clinicians will receive an email describing the BPA and order set, along with internet links to MD Quit Line without additional supplemental education. Best Practices Advisory (BPA): 1. BPA: The BPA is an Epic prompt that fires when a provider opens an encounter with a patient who is actively smoking. Providers will be asked to assess smoking cessation readiness and to refer patients to the free Maryland Quit Line if the patient is receptive. The Quit Line will receive an electronic referral with the patient's details. A Quit Line certified smoking cessation counselor will then call the patient at a later date and provide counseling. Receptive patient will receive up to four calls. They will receive counseling from a trained quit coach and be offered free access to NRT. 2\. Quit Line: This free telephone-based counseling service is offered to smoker in Maryland. Services offered include on-the-phone smoking cessation counseling and free nicotine replacement.	BPA+ Enhanced Education n=5636 Eligible Encounters Clinicians will receive an email describing the new smoking BPA, educational materials offered, and a small tutorial on using the BPA and a new smoking cessation smart set in Epic. Education materials will include the educational hand out and academic detailing from Maryland Quit Line counselors. BPA + Enhanced Education: BPA with Quitline Referral plus 1)Consolidated educational hand out: The hand out will include a information about counseling, pharmacotherapy, and cessation referrals 2)Online modules: Providers will be directed to optional, self-paced educational modules through the Maryland HABITS program 3)Academic detailing: This will include a single session during a clinic day in which counseling experts from the MD Quit Line will visit providers in their practice setting.
Provider Electronic Referrals to the Maryland Quit Line	—	—	623 referrals	405 referrals

SECONDARY outcome

Timeframe: 12 months

Population: Data was not collected for this outcome measure.

Nicotine replacement, Varenicline or Bupropion prescription.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 6 months

Population: This assessment was on number of service referrals and not individual participants. Individual participants analyzed was not collected. This assessment was not done for Waitlist control groups A and B. Due to differences in the timeline of data collection between data from the EMR (within the trial period) and those received from the quitline (monthly summary reports), there are minor discrepancies between the referral totals of this outcome and outcome 1.

Number of patients that accepted services or declined or were not reached or were already enrolled.

Outcome measures

Outcome measures
Measure	Waitlist Control - A BPA+ Enhanced Education will be rolled out to waitlist control sites after 6 months.	Waitlist Control - B BPA will be rolled out to waitlist control sites after 6 months.	Best Practices Advisory (BPA) n=626 Number of service referrals Clinicians will receive an email describing the BPA and order set, along with internet links to MD Quit Line without additional supplemental education. Best Practices Advisory (BPA): 1. BPA: The BPA is an Epic prompt that fires when a provider opens an encounter with a patient who is actively smoking. Providers will be asked to assess smoking cessation readiness and to refer patients to the free Maryland Quit Line if the patient is receptive. The Quit Line will receive an electronic referral with the patient's details. A Quit Line certified smoking cessation counselor will then call the patient at a later date and provide counseling. Receptive patient will receive up to four calls. They will receive counseling from a trained quit coach and be offered free access to NRT. 2\. Quit Line: This free telephone-based counseling service is offered to smoker in Maryland. Services offered include on-the-phone smoking cessation counseling and free nicotine replacement.	BPA+ Enhanced Education n=392 Number of service referrals Clinicians will receive an email describing the new smoking BPA, educational materials offered, and a small tutorial on using the BPA and a new smoking cessation smart set in Epic. Education materials will include the educational hand out and academic detailing from Maryland Quit Line counselors. BPA + Enhanced Education: BPA with Quitline Referral plus 1)Consolidated educational hand out: The hand out will include a information about counseling, pharmacotherapy, and cessation referrals 2)Online modules: Providers will be directed to optional, self-paced educational modules through the Maryland HABITS program 3)Academic detailing: This will include a single session during a clinic day in which counseling experts from the MD Quit Line will visit providers in their practice setting.
Patient Engagement With the Quit Line Accepted services	—	—	133 service referrals	80 service referrals
Patient Engagement With the Quit Line Declined	—	—	27 service referrals	17 service referrals
Patient Engagement With the Quit Line Already enrolled	—	—	6 service referrals	4 service referrals
Patient Engagement With the Quit Line Not reached	—	—	346 service referrals	216 service referrals
Patient Engagement With the Quit Line Pending/incomplete	—	—	114 service referrals	75 service referrals

SECONDARY outcome

Timeframe: 12 months

Population: This assessment was on number of service referrals made out of eligible encounters and not individual participants. Individual participants analyzed was not collected.

Number of referrals made out of total eligible for referral.

Outcome measures

Outcome measures
Measure	Waitlist Control - A n=3635 Eligible Encounters BPA+ Enhanced Education will be rolled out to waitlist control sites after 6 months.	Waitlist Control - B n=3337 Eligible Encounters BPA will be rolled out to waitlist control sites after 6 months.	Best Practices Advisory (BPA) n=5797 Eligible Encounters Clinicians will receive an email describing the BPA and order set, along with internet links to MD Quit Line without additional supplemental education. Best Practices Advisory (BPA): 1. BPA: The BPA is an Epic prompt that fires when a provider opens an encounter with a patient who is actively smoking. Providers will be asked to assess smoking cessation readiness and to refer patients to the free Maryland Quit Line if the patient is receptive. The Quit Line will receive an electronic referral with the patient's details. A Quit Line certified smoking cessation counselor will then call the patient at a later date and provide counseling. Receptive patient will receive up to four calls. They will receive counseling from a trained quit coach and be offered free access to NRT. 2\. Quit Line: This free telephone-based counseling service is offered to smoker in Maryland. Services offered include on-the-phone smoking cessation counseling and free nicotine replacement.	BPA+ Enhanced Education n=4881 Eligible Encounters Clinicians will receive an email describing the new smoking BPA, educational materials offered, and a small tutorial on using the BPA and a new smoking cessation smart set in Epic. Education materials will include the educational hand out and academic detailing from Maryland Quit Line counselors. BPA + Enhanced Education: BPA with Quitline Referral plus 1)Consolidated educational hand out: The hand out will include a information about counseling, pharmacotherapy, and cessation referrals 2)Online modules: Providers will be directed to optional, self-paced educational modules through the Maryland HABITS program 3)Academic detailing: This will include a single session during a clinic day in which counseling experts from the MD Quit Line will visit providers in their practice setting.
Provider Electronic Referrals to the Maryland Quit Line	272 referrals	186 referrals	284 referrals	203 referrals

SECONDARY outcome

Timeframe: 12 months

Population: This assessment was on number of service referrals and not individual participants. Individual participants analyzed was not collected. This assessment was not done for Waitlist control groups A and B.

Number of patients that accepted services or declined or were not reached or were already enrolled.

Outcome measures

Outcome measures
Measure	Waitlist Control - A BPA+ Enhanced Education will be rolled out to waitlist control sites after 6 months.	Waitlist Control - B BPA will be rolled out to waitlist control sites after 6 months.	Best Practices Advisory (BPA) Clinicians will receive an email describing the BPA and order set, along with internet links to MD Quit Line without additional supplemental education. Best Practices Advisory (BPA): 1. BPA: The BPA is an Epic prompt that fires when a provider opens an encounter with a patient who is actively smoking. Providers will be asked to assess smoking cessation readiness and to refer patients to the free Maryland Quit Line if the patient is receptive. The Quit Line will receive an electronic referral with the patient's details. A Quit Line certified smoking cessation counselor will then call the patient at a later date and provide counseling. Receptive patient will receive up to four calls. They will receive counseling from a trained quit coach and be offered free access to NRT. 2\. Quit Line: This free telephone-based counseling service is offered to smoker in Maryland. Services offered include on-the-phone smoking cessation counseling and free nicotine replacement.	BPA+ Enhanced Education Clinicians will receive an email describing the new smoking BPA, educational materials offered, and a small tutorial on using the BPA and a new smoking cessation smart set in Epic. Education materials will include the educational hand out and academic detailing from Maryland Quit Line counselors. BPA + Enhanced Education: BPA with Quitline Referral plus 1)Consolidated educational hand out: The hand out will include a information about counseling, pharmacotherapy, and cessation referrals 2)Online modules: Providers will be directed to optional, self-paced educational modules through the Maryland HABITS program 3)Academic detailing: This will include a single session during a clinic day in which counseling experts from the MD Quit Line will visit providers in their practice setting.
Patient Engagement With the Quit Line Accepted services	—	—	100 service referrals	80 service referrals
Patient Engagement With the Quit Line Declined	—	—	80 service referrals	77 service referrals
Patient Engagement With the Quit Line Already enrolled	—	—	6 service referrals	7 service referrals
Patient Engagement With the Quit Line Not reached	—	—	289 service referrals	291 service referrals
Patient Engagement With the Quit Line Pending/incomplete	—	—	39 service referrals	32 service referrals

Adverse Events

Waitlist Control - A

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Waitlist Control - B

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Best Practices Advisory (BPA)

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

BPA+ Enhanced Education

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Geetanjali Chander

Johns Hopkins University

Phone: 443-287-2030

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place