Trends in smoking documentation rates in safety net clinics.

Objective: To assess the impact of provider incentive policy on smoking status documentation.

Data Sources: Primary data were extracted from structured electronic medical records (EMRs) from 15 community health centers (CHCs).

Study Design: This was an observational study of data from 2006 to 2013, assessing changes in documentation of smoking status over time.

Data Extraction Methods: We extracted structured EMR data for patients age 18 and older with at least one primary care visit.

Principal Findings: Rates of documented smoking status rose from 30 percent in 2006 to 90 percent in 2013; the largest increase occurred from 2011 to 2012 following policy changes (21.3% [95% CI, 8.2%, 34.4%] from the overall trend). Rates varied by clinic and across patient subgroups.

Conclusions: Documentation of smoking status improved markedly after introduction of new federal standards. Further improvement in documentation is still needed, especially for males, nonwhite patients, those using opioids, and HIV + patients. More research is needed to study whether changes in documentation lead to improvements in counseling, cessation, and patient outcomes.