Summary of Previously Published Studies of the Vital Sign Intervention
| Study | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Feature | Robinson et al12 (1995) | Fiore et al11 (1995) | Ahluwalia et al13 (1999) | Piper et al14 (2003) | Boyle and Solberg15 (2004) | Milch et al16 (2004) | Maizlish et al17 (2006) | ||
| NRT = nicotine replacement therapy. | |||||||||
| Note: For cells containing a dash (–), there were no equivalent measures or data. | |||||||||
| a Exact number of smokers in baseline sample was not reported. | |||||||||
| b Control vs intervention. | |||||||||
| c Change was statistically significant. | |||||||||
| d Control vs routine vital sign. Change was larger for control vs enhanced vital sign arm of the study. | |||||||||
| Setting | 1 family practice residency training site | 1 academic internal medicine clinic | 1 inner-city residency walk-in clinic | 5 clinics | 2 clinics | 5 teams in 1 hospital-based primary care practice | 7 community health centers | ||
| Design | Before and after | Before and after | Intervention and control alternating every2 weeks | Randomization of practices to intervention or control | Phone survey before and after institution of vital sign measure | Nonrandom allocation of 2 teams to routine vital signs or enhanced vital signs; 3 teams as controls | Before and after | ||
| Number of participants (smokers) | 637 (179) | 1,864 (254) | 2,811 (883) | 9,439 (1,611) | 4,667 (332) | 3,063 (644) | 1,571 (≈267)a | ||
| Ask (A1) | |||||||||
| Measure | – | Patients’ report of physician asking if they smoke | Patients’ report of physician asking if they smoked cigarettes | Patients’ report of physician asking if they smoke | Visits with chart evidence of tobacco use documentation | Medical record documentation of smoking status | Medical record documentation of smoking status | ||
| Changeb | – | 25.5% vs 52.6%c | 45.6% vs 78.4%c | 24.0% vs 41.2%c | 38.0% vs 78.4%c | 49% vs 86%c,d | 57% vs 85%c | ||
| Any counseling (A2–5) | |||||||||
| Measure | Visits in which physician discussed smoking | – | – | – | Visits with chart evidence of tobacco use documentation | Chart evidence of advising, quitting, setting quit date, referral or pharmacotherapy | – | ||
| Changeb | 47% vs 86%c | – | – | – | 33.5% vs 18.8%c | 30% vs 38%d | – | ||
| Advise (A2) | |||||||||
| Measure | Visits in which physician advised quitting | Smokers’ report of physician advice to quit | Smokers’ report of physician telling them to quit | Smokers’ report of physician advice to quit | Smokers’ report of advice to quit | – | Medical record documentation of advice to quit | ||
| Changeb | 50% vs 80%c | 48.8% vs 69.8%c | 26.9% vs 39.9%c | 60.0% vs 37.1%c | 66.3% vs 66.5% | – | 26% vs 26% | ||
| Further discussion (A3–5) | |||||||||
| Measure | Smokers’ report of physician advice on how to quit | – | – | – | – | – | – | ||
| Changeb | 23.8% vs 42.6%c | – | – | – | – | – | – | ||
| Assist (A4) | |||||||||
| Measure | – | – | Smokers’ report of physician helping to set quit date | Smokers’ report of physician assistance with how to quit | Smokers’ report of physician helping to set quit date | Smokers’ report of NRT prescription | – | – | – |
| Changeb | – | – | <1% vs <1% | 2.8% vs 4.8%c | 4.4% vs 1.5%c | 8.5% vs 1.9%c | – | – | – |
| Arrange (A5) | |||||||||
| Measure | – | – | Smokers’ report that physician arranged follow-up | – | – | – | – | ||
| Changeb | – | – | 6.2% vs 12.3%c | – | – | – | – | ||