• Mona Sharifi, William G Adams, Jonathan P Winickoff, Jing Guo, Margaret Reid, and Renée Boynton-Jarrett.
• Division of General Academic Pediatrics/Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Mass. Electronic address: msharifi@partners.org.
• Acad Pediatr. 2014 Sep 1;14(5):478-84.

ObjectiveTo assess the impact of an electronic health record (EHR) modification and brief clinician training on tobacco smoke exposure (TSE) management in pediatric primary care.MethodsWithin a teaching hospital-based, urban primary care setting, we modified the EHR to include TSE screening prompts, decision support, educational literature, and simplified referral to the state quit line (QuitWorks). A brief training was conducted for the 48 clinic physicians (34 residents and 14 attendings). We collected cross-sectional, independent, random samples of EHR data from well-child visits for children ≤12 years old seen 3 months before (2024 visits) and 3 months after (1895 visits) the intervention and pooled client data from QuitWorks to evaluate TSE screening, counseling, and quit-line referrals. A needs assessment questionnaire examined preintervention attitudes and practice around TSE management; follow-up questionnaires explored satisfaction and subjective changes in skills.ResultsThe baseline needs assessment revealed that although most clinicians agreed that it is appropriate for pediatricians to conduct TSE screening, counseling, and referral during well-child visits, only about half screened, 42% counseled, and 28% routinely offered to refer smoking parents. In pre-post analyses of 117 and 112 EHR-documented positive screens, the intervention was associated with a 16-fold greater likelihood of counseling among positive screens (adjusted odds ratio 16.12; 95% confidence interval 7.28, 35.68). Referrals to QuitWorks increased from 1 before to 31 after the intervention.ConclusionsImplementation of EHR modifications and a brief training to support TSE management was associated with higher rates of counseling and quit-line referrals for parents who smoke.Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

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