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Project Report:
HIT2
Using Electronic Medical
Records to Measure and
Improve Adherence to Tobacco
Treatment Guidelines in
Primary Care |
Tobacco-related disease remains the
leading cause of death in the United States
and a major cause of medical
expenditures and productivity losses.
Fortunately, there is strong evidence that
advice and assistance from primary care
physicians can significantly increase
cessation rates among patients who
smoke. To combat tobacco use, the US
Department of Health and Human
Services PHS produced an evidencebased
clinical-practice guideline, which
recommends that clinicians provide
smokers with the "5-A's" cessation
services. Population-based studies on the
implementation of the 5-As guidelines has
been hampered by the lack of an efficient
and accurate measure of service delivery.
To meet this need, HMOs Investigating
Tobacco 2 (HIT2) has developed
innovative approach for collecting
tobacco treatment data from structured
and free text fields from electronic medical
records. In the first phase of the study, a
team of tobacco cessation experts
developed a concept map for defining
coding rules consistent with the established
national guidelines for tobacco cessation
treatment (the 5-A's). These concepts were
then used in the development of a natural
language coding program called
MediClass using examples of medical
records from each of the four HIT 2 sites.
While this developmental work was
underway, each of the four HIT 2 sites
(KP Hawaii, KP Colorado, KP
Northwest, and Harvard Pilgrim) had to
develop local procedures for extracting
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PI's Office Hits the Road - KPH Site Visit
As many of you may remember,
during the first four years of the
CRN, Ed Wagner and Sarah Greene
visited different CRN sites in an
effort to learn more about the
individual sites. The site visits were
originally prompted by qualitative
data from the CRN Evaluation
which conveyed a desire for greater
connectivity between the sites and the
PI's office. These in-person meetings
have proven to be extremely helpful
for better understanding the unique
scientific strengths and operational
complexities of each site, and have
served as one important vehicle to
help us navigate the challenges of
multisite research.
CRN Connection
CRN Connection
The CRN Connection is a publication of the CRN developed
to inform and occasionally entertain CRN
collaborators. It is produced with oversight from the
CRN Communications Committee.
Contributors. . . . . . . . . . . . Gary Ansell, Martin Brown,
.. . . . . . . . . . . . . . . . . .Maurleen Davidson, Sarah Greene,
. . . . . . . . . . . . . . . . . . . . . . . . . . . Gene Hart, Steve Taplin,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .and Ed Wagner
Oversight. . . . . . . . . . . . . . . .Gary Ansell, Martin Brown,
. . . . . . . . . . . . Sarah Greene, Chelsea Jenter, Gene Hart,
. . . . . . . . . . . . . . . . . . . . .Kimberly Hill, Judy Mouchawar
. . . . . . . . . . . . . . . . . . . . . Dennis Tolsma, and Ed Wagner
Produced by. . . . . . . . . . . . . . . . . . . ..Maurleen Davidson
Please send comments or suggestions on this newsletter
to Maurleen Davidson, CRN Connection Editor, at
davidson.ms@ghc.org. All submissions are welcome!
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Sarah Greene, in her relatively new role
as Scientific Research Associate, and
Chelsea Jenter, the relatively new CRN
Project Director, conducted their first
site visit together at Kaiser
Permanente Hawaii in late March.
The site visit included meetings
covering everything from SDRC
topics to administrative issues. The
site visit also afforded the opportunity
to meet KPH's newest coinvestigator,
Melissa Finucane, PhD,
whose primary area of research
interest is risk assessment and decision
making.
One of the highlights was a scientific
brainstorming session that KPH
organized, with collaborators from
Cancer Research Center of Hawaii
(Carolyn Gotay PhD, and Loic
LeMarchand, MD, PhD) and the
University of Hawaii Medical School
(Jimmy Thomas Efird, PhD).
Given the amount of CRN business
transacted by conference calls, we've
found it invaluable to meet with
colleagues in person. Seeing the
research environment, and simply
knowing what our colleagues look
like, are two of the many intangibles
that contribute to better overall
functioning as a Network. The CRN
road show has now visited six sites in
five states, and will be back on tour
again soon. Maybe we should budget
for an RV in the next renewal.
-Sarah Greene and Chelsea Jenter, GHC
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