C102-01 Improving Tobacco Treatment Reach Through a Learning Health System: Lessons From ELEVATE

Abstract Introduction Clinical guidelines provide clear, evidence-based recommendations for smoking cessation management, yet these approaches remain underused in practice. Persistent barriers, including limited resources and workflow constraints, have hindered widespread adoption of smoking cessation management strategies. To address these challenges, point-of-care models have been developed to integrate smoking cessation management directly into clinical encounters. A point-of-care, electronic health record-enabled, evidence-based tobacco treatment program (ELEVATE) was implemented across multiple clinics within a large academic medical center. In this study, we evaluated the reach and effectiveness of ELEVATE in delivering tobacco treatment services to patients in these clinics. Methods We compared data between two six-month periods: before ELEVATE implementation (January 1-June 30, 2024) and after implementation (July 1- December 31, 2024). A multivariable generalized estimating equation (GEE) model was used to evaluate the program’s reach in delivering tobacco treatment interventions. Smoking cessation rates within six months following each patient’s visit were analyzed to evaluate program effectiveness through the same logistic regression model. Quit rates were also analyzed based on treatment status among patients within the two time periods. Results There were 106,911 unique patient encounters during the pre-ELEVATE period and 110,882 encounters during the post- ELEVATE period (5,159 and 5,520 encounters were from pulmonary clinics, respectively). Smoking prevalence was approximately 10% across the total population. Tobacco treatment reach increased from 20.9% pre-ELEVATE to 29.7% post-ELEVATE (Figure; odds ratio OR = 1.39; 95% confidence interval CI = 1.31-1.47; p 0.0001). Smoking abstinence rates within six months also improved from 11.9% to 15.9% (OR = 1.29; 95% CI = 1.21-1.37; p 0.0001). The pulmonary subspeciality had the highest reach of tobacco treatment prior to implementation of ELEVATE, and increased from 42.6% to 47.3% post-ELEVATE. The quit rates were higher among patients who received tobacco treatment compared to those who did not in both the pre-ELEVATE (OR = 3.41; 95% CI = 3.01-3.88; p 0.0001) and post-ELEVATE periods (OR = 5.03; 95% CI = 4.51-5.61; p 0.0001). Conclusions Implementation of the ELEVATE was associated with significant improvement in both the reach and effectiveness of tobacco treatment. However, overall tobacco treatment reach does remain suboptimal. Next steps include a needs assessment to highlight key barriers that could inform targeted adaptations to enhance the program’s future implementation and sustainment. This abstract is funded by: NIH