***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . OBJECTIVE To test the effectiveness of a care coordination program for telephone counseling in raising referral and treatment rates for  smoking cessation . STUDY DESIGN A demonstration project implementing a smoking cessation care coordination program offering telephone counseling and medication management to patients referred from primary care . METHODS The study was performed at 18 Veterans Health Administration ( VA ) sites in California . Participants were VA patients receiving primary care . We r and omly allocated 10 of 18 sites to receive the Telephone Care Coordination Program , which included simple 2-click referral , proactive care coordination , medication management , and 5 follow-up telephone calls . Each patient received a 30- to 45-minute counseling session from the California Smokers ' Helpline . Patients at control sites received usual care . RESULTS During 10 months , we received 2965 referrals . We were unable to reach 1156 patients ( 39 % ) , despite at least 3 attempts . We excluded 73 patients ( 3 % ) , and 391 patients ( 13 % ) were not interested . We connected the remaining 1345 patients ( 45 % ) to the Helpline . At 6-month followup , 335 patients ( 11 % of all referrals and 25 % of participating patients ) were abstinent . Providers at intervention sites reported referring many more patients to telephone counseling than providers at control sites ( 15.6 vs 0.7 in the prior month ) . CONCLUSIONS The program generated a large number of referrals ; almost half of the patients referred were connected with the Helpline . Long-term abstinence was excellent . These results suggest that managed care organizations may be able to improve tobacco control by implementing a similar system of care coordination AIMS To establish whether proactively identifying all smokers in primary care population s and offering smoking cessation support is effective in increasing long-term abstinence from smoking . DESIGN Cluster r and omized controlled trial . SETTING Twenty-four general practice s in Nottinghamshire , r and omized by practice to active or control intervention . PARTICIPANTS All adult patients registered with the practice s who returned a question naire confirming that they were current smokers ( n = 6856 ) . INTERVENTION Participants were offered smoking cessation support by letter and those interested in receiving it were contacted and referred into National Health Service ( NHS ) stop smoking services if required . MEASUREMENTS Vali date d abstinence from smoking , use of smoking cessation services and number of quit attempts in continuing smokers at 6 months . FINDINGS Smokers in the intervention group were more likely than controls to report that they had used local cessation services during the study period [ 16.6 % and 8.9 % , respectively , adjusted odds ratio ( OR ) 2.09 , 95 % confidence interval ( CI ) 1.57 - 2.78 ] , and continuing smokers ( in the intervention group ) were more likely to have made a quit attempt in the last 6 months ( 37.4 % and 33.3 % , respectively , adjusted OR 1.23 , 95 % CI 1.01 - 1.51 ) . Vali date d point prevalence abstinence from smoking at 6 months was higher in the intervention than the control groups ( 3.5 % and 2.5 % , respectively ) but the difference was not statistically significant ( adjusted OR controlling for covariates : 1.64 , 95 % CI 0.92 - 2.89 ) . CONCLUSIONS Proactively identifying smokers who want to quit in primary care population s , and referring them to a cessation service , increased contacts with cessation services and the number of quit attempts . We were unable to detect a significant effect on long-term cessation rates , but the study was not powered to detect the kind of difference that might be expected Background : Strategies to improve smoking cessation counseling in clinical setting s are critical to supporting smokers ’ attempts to quit . This study evaluates the impact of adding 2 smoking-related vital sign questions in an electronic medical records system on identification , assessment , and counseling for patients who smoke : “ Current smoker ? ” and “ Plan to quit ? ” Methods : Baseline data and data after intervention were collected through record review of 899 r and omly selected patient visits across 3 outpatient clinics . Results : From before to after intervention , identification of smokers increased 18 % ( from 71 % to 84 % ; P < .001 ) , and assessment for a plan to quit increased 100 % ( from 25.5 % to 51 % ; P < .005 ) . Among all smokers , cessation counseling increased 26 % ( from 23.6 % to 29.8 % ; P = .41 ) . Significantly more smokers who received the  assessment for a plan to quit received cessation counseling ( 46 % vs. 14 % , P < .001 ) . Regression analysis showed that patients receiving an  assessment for plan to quit were 80 % more likely to receive cessation counseling ( OR 0.209 ; 95 % CI , 0.095–0.456 ) . Conclusions : Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit . Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling BACKGROUND Preventive care is an important role for general practitioners , yet opportunities for prevention are often missed . METHOD We provided an automatic electronic record preventive care reminder system for  12 preventive care activities for one 10 doctor practice . All patients who attended were r and omised by the terminal digit of their record number . RESULTS The control uptake of opportunistic prevention was low ; ranging from 1.5 % ( tetanus immunisation ) to 27 % ( influenza immunisation ) . The reminders increased this by significant but small amounts for four out of 12 activities ( immunisation for tetanus and pneumococcus and recording of allergies and weight ) , insignificant increases for four ( mumps , measles and rubella immunisation , recording of smoking , and taking of cervical smears and of blood pressure ) , and insignificantly decreased influenza immunisation , and screening for diabetes and hyperlipidaemia . DISCUSSION Opportunistic electronic reminders have the potential to increase preventive care in general practice BACKGROUND To improve the documentation and treatment of tobacco use in primary care , we developed and implemented a 3-part electronic health record enhancement : (1)smoking status icons , ( 2 ) tobacco treatment reminders , and ( 3 ) a Tobacco Smart Form that facilitated the ordering of medication and fax and e-mail counseling referrals . METHODS We performed a cluster-r and omized controlled trial of the enhancement in 26 primary care practice s between December 19 , 2006 , and September 30 , 2007 . The primary outcome was the proportion of documented smokers who made contact with a smoking cessation counselor .  Secondary outcomes included coded smoking status documentation and medication prescribing . RESULTS During the 9-month study period , 132 630 patients made 315 962 visits to study practice s.  Coded documentation of smoking status increased from 37 % of patients to 54 % ( + 17 % ) in intervention practice s and from 35 % of patients to 46 % ( + 11 % ) in control practice s ( P < .001 for the difference in differences ) . Among the 9589 patients who were documented smokers at the start of the study , more patients in the intervention practice s were recorded as nonsmokers by the end of the study ( 5.3 % vs 1.9 % in control practice s ; P < .001 ) . Among 12 207 documented smokers , more patients in the intervention practice s made contact with a cessation counselor ( 3.9 % vs 0.3 % in control practice s ; P < .001 ) . Smokers in the intervention practice s were no more likely to be prescribed smoking cessation medication ( 2 % vs 2 % in control practice s ; P = .40 ) . CONCLUSION This electronic health record-based intervention improved smoking status documentation and increased counseling assistance to smokers but not the prescription of cessation medication The electronic health record ( EHR ) may be an effective tool to help clinicians address tobacco use more consistently . To evaluate the impact of EHR-generated practice feedback on rates of referral to a state-level tobacco quitline , we conducted a cluster r and omized clinical trial ( feedback versus no feedback ) within 19 primary care clinics in Oregon . Intervention clinics received provider-specific monthly feedback reports generated from EHR data . The reports rated provider performance in asking , advising , assessing , and assisting with tobacco cessation compared with a clinic average and an achievable benchmark of care . During 12 months of follow-up , EHR-documented rates of advising , assessing , and assisting were significantly improved in the intervention clinics compared with the control clinics ( p<.001 ) . A higher case-mix index and presence of a clinic champion were associated with higher rates of referral to a state-level quitline . EHR-generated provider feedback improved documentation of assistance with tobacco cessation . Connecting physician offices to a state-level quitline was feasible and well accepted BACKGROUND Lack of interest has been cited as a reason not to offer cessation assistance to smokers , but research suggests that smokers accept treatments offered proactively . This study assessed acceptability , utilization , and effectiveness of free smoking cessation treatment among diverse primary care patients . METHOD Medical assistants invited 4174 adult smokers to participate . Enrollees ( 1869 ) self-selected or were assigned to receive free nicotine patch therapy alone or in combination with the Committed Quitters(R ) program , and for some , individual counseling . RESULTS In nearly 68 % of cases , patients accepted a treatment invitation ; 77 % of eligible smokers enrolled ; 85 % of these picked up free patches . Given a choice of treatments , 75 % of participants elected a psychosocial treatment in addition to patch therapy . Thirteen percent of treatment initiators achieved biochemically confirmed 7-day point-prevalence abstinence at 1 year , with no significant treatment effects . Minority patients showed greater initial interest but less utilization did than White patients . CONCLUSIONS Free , readily accessible smoking cessation treatment offered in primary care setting s was accepted and used by the majority of unselected smokers of diverse racial/ethnic origins . Psychosocial treatment components did not significantly increase abstinence rates . Barriers , rather than lack of interest , may keep minority smokers from using cessation treatments PURPOSE We undertook a study to assess the impact of comparative feedback vs general reminders on practice -based referrals to a tobacco cessation quit line and estimated costs for projected quit responses . METHODS We conducted a group-r and omized clinical trial comparing the impact of 6 quarterly ( 18 months ) feedback reports ( intervention ) with that of general reminders ( control ) on practice -based clinician referrals to a quit-line service .  Feedback reports were based on an Achievable Benchmark of Care approach using baseline practice , clinician , and patient survey responses , and referrals per quarter . Comparable quit responses and costs were estimated . RESULTS Three hundred eight clinicians participated ( 171 family medicine , 88 internal medicine , 49 obstetrics-gynecology ) from 87 primary care practice s in Michigan . After 18 months , there were more referrals from the intervention than from the control practice s ( 484 vs 220 ; P < .001 ) . Practice facsimile ( fax ) referrals ( 84 % , n = 595 ) exceeded telephone referrals ( 16 % , n = 109 ) , but telephone referrals result ed in greater likelihood of enrollment ( 77 % telephone vs 44 % fax , P < .001 ) . The estimated number of smokers who quit based on the level of services utilized by referred smokers was 66 in the feedback and 36 in the gentle reminder practice s. CONCLUSION Providing comparative feedback on clinician referrals to a quit-line service had a modest impact with limited increased costs 
    Output:
    
Adding tobacco status as a vital sign result ed in an increase in some clinical guideline recommended actions , particularly documentation of smoking status .
There was insufficient evidence to quantify the effect of an EMR on changes in patient smoking behaviors .