Volume 55 | Number 2 | April 2020

Abstract List

Stephen P. Fortmann MD, Steffani R. Bailey PhD, Neon B. Brooks PhD, Brian Hitsman PhD, Sarah Stuart Rittner MA, Suzanne E. Gillespie MS, Christian Nissen Hill MD, MPH, Michael C. Leo PhD, Phillip M. Crawford MS, Weiming Hu MS, Dana S. King BA, ALM, Conall O'Cleirigh PhD, Jon Puro MPA, HA, Mary Ann McBurnie PhD


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.


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.