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A Comparison of Smoking History in the Electronic Health Record With Self-Report.

Abstract

INTRODUCTION

Knowing patients' smoking history helps guide who may benefit from preventive services such as lung cancer screening. The accuracy of smoking history electronic health records remains unclear.

METHODS

This was a secondary analysis of data collected from a portal-based lung cancer screening decision aid. Participants of an academically affiliated health system, aged 55-76 years, completed an online survey that collected a detailed smoking history including years of smoking, years since quitting, and smoking intensity. Eligibility for lung cancer screening was defined using the Centers for Medicare and Medicaid Services criteria. Data analysis was performed May-December 2018, and data collection occurred between November 2016 and February 2017.

RESULTS

A total of 336 participants completed the survey and were included in the analysis. Of 175 participants with self-reported smoking intensity, 72% had packs per day and 62% had pack-years recorded in the electronic health record. When present, smoking history in the electronic health records correlated well with self-reported years of smoking (r =0.78, p≤0.0001) and years since quitting (r =0.94, p≤0.0001). Self-reported smoking intensity, including pack-years (r =0.62, p<0.0001) and packs per day (r =0.65, p≤0.0001), was less correlated. Of those participants eligible for lung cancer screening by self-report, only 35% met criteria for screening by electronic health records data alone. Others were either incorrectly classified as ineligible (23%) or had incomplete data (41%).

CONCLUSIONS

The electronic health records frequently misses critical elements of a smoking history, and when present, it often underestimates smoking intensity, which may impact who receives lung cancer screening.

Authors+Show Affiliations

Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: nikpatel@wakehealth.edu.Section of General Internal Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.Section of General Internal Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31982229

Citation

Patel, Nikhil, et al. "A Comparison of Smoking History in the Electronic Health Record With Self-Report." American Journal of Preventive Medicine, 2020.
Patel N, Miller DP, Snavely AC, et al. A Comparison of Smoking History in the Electronic Health Record With Self-Report. Am J Prev Med. 2020.
Patel, N., Miller, D. P., Snavely, A. C., Bellinger, C., Foley, K. L., Case, D., ... Dharod, A. (2020). A Comparison of Smoking History in the Electronic Health Record With Self-Report. American Journal of Preventive Medicine, doi:10.1016/j.amepre.2019.10.020.
Patel N, et al. A Comparison of Smoking History in the Electronic Health Record With Self-Report. Am J Prev Med. 2020 Jan 22; PubMed PMID: 31982229.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Comparison of Smoking History in the Electronic Health Record With Self-Report. AU - Patel,Nikhil, AU - Miller,David P,Jr AU - Snavely,Anna C, AU - Bellinger,Christina, AU - Foley,Kristie L, AU - Case,Doug, AU - McDonald,Malcolm L, AU - Masmoudi,Youssef R, AU - Dharod,Ajay, Y1 - 2020/01/22/ PY - 2019/07/26/received PY - 2019/10/28/revised PY - 2019/10/29/accepted PY - 2020/1/27/entrez PY - 2020/1/27/pubmed PY - 2020/1/27/medline JF - American journal of preventive medicine JO - Am J Prev Med N2 - INTRODUCTION: Knowing patients' smoking history helps guide who may benefit from preventive services such as lung cancer screening. The accuracy of smoking history electronic health records remains unclear. METHODS: This was a secondary analysis of data collected from a portal-based lung cancer screening decision aid. Participants of an academically affiliated health system, aged 55-76 years, completed an online survey that collected a detailed smoking history including years of smoking, years since quitting, and smoking intensity. Eligibility for lung cancer screening was defined using the Centers for Medicare and Medicaid Services criteria. Data analysis was performed May-December 2018, and data collection occurred between November 2016 and February 2017. RESULTS: A total of 336 participants completed the survey and were included in the analysis. Of 175 participants with self-reported smoking intensity, 72% had packs per day and 62% had pack-years recorded in the electronic health record. When present, smoking history in the electronic health records correlated well with self-reported years of smoking (r =0.78, p≤0.0001) and years since quitting (r =0.94, p≤0.0001). Self-reported smoking intensity, including pack-years (r =0.62, p<0.0001) and packs per day (r =0.65, p≤0.0001), was less correlated. Of those participants eligible for lung cancer screening by self-report, only 35% met criteria for screening by electronic health records data alone. Others were either incorrectly classified as ineligible (23%) or had incomplete data (41%). CONCLUSIONS: The electronic health records frequently misses critical elements of a smoking history, and when present, it often underestimates smoking intensity, which may impact who receives lung cancer screening. SN - 1873-2607 UR - https://www.unboundmedicine.com/medline/citation/31982229/A_Comparison_of_Smoking_History_in_the_Electronic_Health_Record_With_Self-Report L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-3797(19)30503-3 DB - PRIME DP - Unbound Medicine ER -