Smoking Cessation in Pregnancy and Beyond: A Quality Improvement (QI) Project

Abstract

Smoking during pregnancy is a prevalent and preventable risk factor for adverse outcomes, including prematurity, growth restriction, and perinatal mortality. Brief provider interventions are effective and pregnancy often inspires smoking cessation, but postpartum recidivism is unfortunately common, restoring risk to women, children, and future pregnancies. Frequent patient-provider interactions during the antenatal period and corresponding child’s first year of life offer a unique opportunity to introduce and reinforce healthy lifestyle habits of budding family units. EMR technology can be used to improve quality and continuity of tobacco-free healthcare by optimizing implementation of proven interventions and by synthesizing coordination of care between obstetricians and pediatricians. Force functionality within EPIC can prompt obstetricians to routinely provide cessation support, and hard stops can ensure ongoing assessment of a patient’s status within the Transtheoretical Model of Behavior Change. Well-child templates can then import smoking-related data from prenatal visits into the infant’s chart and prompt pediatricians to provide consistent, patient-specific interventions. The project will test the enriched EMR in a treatment group and compare prevalence of smoking vs. a control group upon admission for delivery and at 1-month, 6-month, and 1-year well-child visits.

Project Motivation: Situation, Background, Assessment, Recommendation (SBAR) and Define, Measure, Analyze, Improve, and Control (DMAIC) tools