Thulasee Jose

All Publications

• Intraoperative Blood Pressure Variability and Early Postoperative Stroke: A Case-Control Study. The American surgeon Valencia Morales, D. J., Garbajs, N. Z., Tawfic, S. S., Jose, T., Laporta, M. L., Schroeder, D. R., Weingarten, T. N., Sprung, J. 2023; 89 (12): 5191-5200

  Abstract

  This study aims to assess the association of postoperative stroke with intraoperative hemodynamic variability and transfusion management.In this case-control study, adult patients (≥ 18 years) who had a stroke within 72 hours of a surgical procedure were matched to 2 control patients according to age, sex, and procedure type. Primary risk factors assessed were intraoperative fluid administration, blood product transfusion, vasopressor use, and measures of variability in systolic and diastolic blood pressure and heart rate: maximum, minimum, range, SD, and average real variability. The variables were analyzed with conditional logistic regression, which accounted for the 1:2 matched case-control study design.Among 687 581 procedures, we identified 64 postoperative strokes (incidence, 9.3 [95% CI, 7.2-11.9] strokes per 100 000 procedures). These cases were matched with 128 controls. Stroke cases had higher Charlson cmorbidity index scores than did controls (P = .046). Blood pressure and heart rate variability measures were not associated with stroke. The risk of stroke was increased with red blood cell (RBC) transfusion (odds ratio [OR], 14.82; 95% CI, 3.40-64.66; P < .001), vasopressor use (OR, 3.91; 95% CI, 1.59-9.60; P = .003), and longer procedure duration (OR, 1.23/h; 95% CI, 1.01-1.51; P = .04). Multivariable analysis of procedure duration, RBC transfusion, and vasopressor use showed that only RBC transfusion was independently associated with an increased risk of stroke (OR, 10.10; 95% CI, 2.14-47.72; P = .004).Blood pressure variability was not associated with an increased risk of postoperative stroke; however, RBC transfusion was an independent risk factor.

  View details for DOI 10.1177/00031348221136578

  View details for PubMedID 36426383

• Effect of Messaging Content on Engagement With a Short Messaging Service for Perioperative Smoking Cessation. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Jose, T., Cha, S., Graham, A. L., Amato, M. S., Schroeder, D. R., Warner, D. O. 2023; 25 (8): 1465-1473

  Abstract

  We determined whether a tobacco cessation intervention targeting brief perioperative abstinence ("quit for a bit") increased engagement of surgical patients with treatment compared with an intervention targeting long-term postoperative abstinence ("quit for good").Surgical patients who smoke were stratified according to intended duration of postoperative abstinence, and then randomized within strata to receive either a "quit for a bit" or a "quit for good" intervention. Both employed initial brief counseling and short message service (SMS) to deliver treatment up to 30 days after surgery. The primary outcome of treatment engagement was defined as the rate at which subjects actively responded to system requests delivered via SMS.The engagement index did not differ between intervention groups (median [25th, 75th] of 23.7% [8.8, 46.0] for "quit for a bit" group (n = 48) and 22.2% [4.8, 46.0] for "quit for good" group (n = 50), p = .74), nor did the proportion of patients continuing SMS use after study completion (33% and 28%, respectively). Exploratory abstinence outcomes on the morning of surgery and 7 and 30 days after surgery did not differ between groups. Program satisfaction was high in both groups and did not differ. There was no significant interaction between intended abstinence duration and any outcome, ie, alignment of intent with intervention did not affect engagement.Tobacco cessation treatment delivered via SMS was well accepted by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates.Treatment of surgical patients for tobacco use is efficacious and reduces postoperative complications. However, implementation in clinical practice has proved challenging, and new methods of engaging these patients in cessation treatment are needed. We found that tobacco use treatment delivered via SMS was feasible and well utilized by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates.NCT03839043. Registry URL: https://clinicaltrials.gov/ct2/show/NCT03839043.

  View details for DOI 10.1093/ntr/ntad061

  View details for PubMedID 37058426

• Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Piasecki, T. M., Smith, S. S., Baker, T. B., Slutske, W. S., Adsit, R. T., Bolt, D. M., Conner, K. L., Bernstein, S. L., Eng, O. D., Lazuk, D., Gonzalez, A., Jorenby, D. E., D'Angelo, H., Kirsch, J. A., Williams, B. S., Nolan, M. B., Hayes-Birchler, T., Kent, S., Kim, H., Lubanski, S., Yu, M., Suk, Y., Cai, Y., Kashyap, N., Mathew, J. P., McMahan, G., Rolland, B., Tindle, H. A., Warren, G. W., An, L. C., Boyd, A. D., Brunzell, D. H., Carrillo, V., Chen, L. S., Davis, J. M., Deshmukh, V. G., Dilip, D., Ellerbeck, E. F., Goldstein, A. O., Iturrate, E., Jose, T., Khanna, N., King, A., Klass, E., Mermelstein, R. J., Tong, E., Tsoh, J. Y., Wilson, K. M., Theobald, W. E., Fiore, M. C. 2023; 25 (6): 1184-1193

  Abstract

  Available evidence is mixed concerning associations between smoking status and COVID-19 clinical outcomes. Effects of nicotine replacement therapy (NRT) and vaccination status on COVID-19 outcomes in smokers are unknown.Electronic health record data from 104 590 COVID-19 patients hospitalized February 1, 2020 to September 30, 2021 in 21 U.S. health systems were analyzed to assess associations of smoking status, in-hospital NRT prescription, and vaccination status with in-hospital death and ICU admission.Current (n = 7764) and never smokers (n = 57 454) did not differ on outcomes after adjustment for age, sex, race, ethnicity, insurance, body mass index, and comorbidities. Former (vs never) smokers (n = 33 101) had higher adjusted odds of death (aOR, 1.11; 95% CI, 1.06-1.17) and ICU admission (aOR, 1.07; 95% CI, 1.04-1.11). Among current smokers, NRT prescription was associated with reduced mortality (aOR, 0.64; 95% CI, 0.50-0.82). Vaccination effects were significantly moderated by smoking status; vaccination was more strongly associated with reduced mortality among current (aOR, 0.29; 95% CI, 0.16-0.66) and former smokers (aOR, 0.47; 95% CI, 0.39-0.57) than for never smokers (aOR, 0.67; 95% CI, 0.57, 0.79). Vaccination was associated with reduced ICU admission more strongly among former (aOR, 0.74; 95% CI, 0.66-0.83) than never smokers (aOR, 0.87; 95% CI, 0.79-0.97).Former but not current smokers hospitalized with COVID-19 are at higher risk for severe outcomes. SARS-CoV-2 vaccination is associated with better hospital outcomes in COVID-19 patients, especially current and former smokers. NRT during COVID-19 hospitalization may reduce mortality for current smokers.Prior findings regarding associations between smoking and severe COVID-19 disease outcomes have been inconsistent. This large cohort study suggests potential beneficial effects of nicotine replacement therapy on COVID-19 outcomes in current smokers and outsized benefits of SARS-CoV-2 vaccination in current and former smokers. Such findings may influence clinical practice and prevention efforts and motivate additional research that explores mechanisms for these effects.

  View details for DOI 10.1093/ntr/ntac201

  View details for PubMedID 36069915

  View details for PubMedCentralID PMC9494410

• Relations of Current and Past Cancer with Severe Outcomes among 104,590 Hospitalized COVID-19 Patients: The COVID EHR Cohort at the University of Wisconsin. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Nolan, M. B., Piasecki, T. M., Smith, S. S., Baker, T. B., Fiore, M. C., Adsit, R. T., Bolt, D. M., Conner, K. L., Bernstein, S. L., Eng, O. D., Lazuk, D., Gonzalez, A., Hayes-Birchler, T., Jorenby, D. E., D'Angelo, H., Kirsch, J. A., Williams, B. S., Kent, S., Kim, H., Lubanski, S. A., Yu, M., Suk, Y., Cai, Y., Kashyap, N., Mathew, J., McMahan, G., Rolland, B., Tindle, H. A., Warren, G. W., Abu-El-Rub, N., An, L. C., Boyd, A. D., Brunzell, D. H., Carrillo, V. A., Chen, L. S., Davis, J. M., Deshmukh, V. G., Dilip, D., Goldstein, A. O., Ha, P. K., Iturrate, E., Jose, T., Khanna, N., King, A., Klass, E., Lui, M., Mermelstein, R. J., Poon, C., Tong, E., Wilson, K. M., Theobald, W. E., Slutske, W. S. 2023; 32 (1): 12-21

  Abstract

  There is mixed evidence about the relations of current versus past cancer with severe COVID-19 outcomes and how they vary by patient and cancer characteristics.Electronic health record data of 104,590 adult hospitalized patients with COVID-19 were obtained from 21 United States health systems from February 2020 through September 2021. In-hospital mortality and ICU admission were predicted from current and past cancer diagnoses. Moderation by patient characteristics, vaccination status, cancer type, and year of the pandemic was examined.6.8% of the patients had current (n = 7,141) and 6.5% had past (n = 6,749) cancer diagnoses. Current cancer predicted both severe outcomes but past cancer did not; adjusted odds ratios (aOR) for mortality were 1.58 [95% confidence interval (CI), 1.46-1.70] and 1.04 (95% CI, 0.96-1.13), respectively. Mortality rates decreased over the pandemic but the incremental risk of current cancer persisted, with the increment being larger among younger vs. older patients. Prior COVID-19 vaccination reduced mortality generally and among those with current cancer (aOR, 0.69; 95% CI, 0.53-0.90).Current cancer, especially among younger patients, posed a substantially increased risk for death and ICU admission among patients with COVID-19; prior COVID-19 vaccination mitigated the risk associated with current cancer. Past history of cancer was not associated with higher risks for severe COVID-19 outcomes for most cancer types.This study clarifies the characteristics that modify the risk associated with cancer on severe COVID-19 outcomes across the first 20 months of the COVID-19 pandemic. See related commentary by Egan et al., p. 3.

  View details for DOI 10.1158/1055-9965.EPI-22-0500

  View details for PubMedID 35965473

  View details for PubMedCentralID PMC9827105

• Changes in Cigarette Smoking Behavior in Cancer Survivors During Diagnosis and Treatment. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Jose, T., Schroeder, D. R., Warner, D. O. 2022; 24 (10): 1581-1588

  Abstract

  Continued cigarette smoking is a critical determinant of outcome in oncology patients, but how the separate events of cancer diagnosis, cancer treatment, and completion of treatment affect smoking behavior in cancer survivors is unknown. This study described such changes, hypothesizing that they would be more pronounced for smoking-related cancers.The Cancer Patient Tobacco Use Questionnaire (CTUQ) was sent to every cancer patient ≥ 18 y old scheduled for outpatient visits at the Mayo Clinic Cancer Center with a current or former history of tobacco use.From September 2019 to September 2020, 33,831 patients received the CTUQ, and 20,818 (62%) responded. Of the 3007 current smokers analyzed, 34% quit at diagnosis; those with smoking-related cancers were more likely to quit (40% vs. 29%, respectively, p < .001). Among those who did not quit at diagnosis, 31% quit after starting cancer treatment, and those with smoking-related cancers were more likely to quit (35% and 28%, respectively, p = .002) Among those who had quit before the completion of treatment, 13% resumed smoking after treatment ended. In multivariable analysis, patients with smoking-related cancers were more likely to report 30-d point prevalence abstinence from pre-diagnosis to the completion of treatment (adjusted OR 1.98 [95% CI 1.65, 2.36], p < .001).Both cancer diagnosis and treatment prompt smoking abstinence, with most maintaining abstinence after treatment is completed. Those with smoking-related cancers are more likely to quit. These results emphasize the need to provide access to tobacco treatment services that can further support cancer patients who smoke.Approximately one-third of cancer patients who smoke quit smoking at the time of diagnosis, an additional one-third of patients who had not yet quit did so at the initiation of treatment, and most sustained this abstinence after treatment completion. Patients with smoking-related cancers are more likely to quit. Thus, there are multiple opportunities within the cancer care continuum to intervene and support quit attempts or continued abstinence.

  View details for DOI 10.1093/ntr/ntac072

  View details for PubMedID 35311999

  View details for PubMedCentralID PMC9575979

• The first 20 months of the COVID-19 pandemic: Mortality, intubation and ICU rates among 104,590 patients hospitalized at 21 United States health systems. PloS one Fiore, M. C., Smith, S. S., Adsit, R. T., Bolt, D. M., Conner, K. L., Bernstein, S. L., Eng, O. D., Lazuk, D., Gonzalez, A., Jorenby, D. E., D'Angelo, H., Kirsch, J. A., Williams, B., Nolan, M. B., Hayes-Birchler, T., Kent, S., Kim, H., Piasecki, T. M., Slutske, W. S., Lubanski, S., Yu, M., Suk, Y., Cai, Y., Kashyap, N., Mathew, J. P., McMahan, G., Rolland, B., Tindle, H. A., Warren, G. W., An, L. C., Boyd, A. D., Brunzell, D. H., Carrillo, V., Chen, L. S., Davis, J. M., Dilip, D., Ellerbeck, E. F., Iturrate, E., Jose, T., Khanna, N., King, A., Klass, E., Newman, M., Shoenbill, K. A., Tong, E., Tsoh, J. Y., Wilson, K. M., Theobald, W. E., Baker, T. B. 2022; 17 (9): e0274571

  Abstract

  There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic.University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR test in a 14-day window (+/- 7 days of hospital admission); and (3) health system contact prior to COVID-19 hospitalization. Outcomes assessed were: (1) mortality (primary), (2) endotracheal intubation, and (3) ICU admission.The 104,590 hospitalized participants had a mean age of 61.7 years and were 50.4% female, 24% Black, and 56.8% White. Overall risk-standardized mortality (adjusted for age, sex, race, ethnicity, body mass index, insurance status and medical comorbidities) declined from 16% of hospitalized COVID-19 patients (95% CI: 16% to 17%) early in the pandemic (February-April 2020) to 9% (CI: 9% to 10%) later (July-September 2021). Among subpopulations, males (vs. females), those on Medicare (vs. those on commercial insurance), the severely obese (vs. normal weight), and those aged 60 and older (vs. younger individuals) had especially high mortality rates both early and late in the pandemic. ICU admission and intubation rates also declined across these 20 months.Mortality, intubation, and ICU admission rates improved markedly over the first 20 months of the pandemic among adult hospitalized COVID-19 patients although gains varied by subpopulation. These data provide important information on the course of COVID-19 and identify hospitalized patient groups at heightened risk for negative outcomes.ClinicalTrials.gov Identifier: NCT04506528 (https://clinicaltrials.gov/ct2/show/NCT04506528).

  View details for DOI 10.1371/journal.pone.0274571

  View details for PubMedID 36170336

  View details for PubMedCentralID PMC9518859

• Utilization of an Electronic Health Record Integrated Risk Score to Predict Hospitalization Among COVID-19 Patients. Journal of primary care & community health Nyman, M. A., Jose, T., Croghan, I. T., Parkulo, M. A., Burger, C. D., Schroeder, D. R., Hurt, R. T., O'Horo, J. C. 2022; 13: 21501319211069748

  Abstract

  To evaluate the performance of an Electronic Health Record (EHR) integrated risk score for COVID-19 positive outpatients to predict 30-day risk of hospitalization.A retrospective observational study of 67 470 patients with COVID-19 confirmed by polymerase chain reaction (PCR) test between March 12, 2020 and February 8, 2021. Risk scores were calculated based on data in the chart at the time of the incident infection.The Mayo Clinic COVID-19 risk score consisted of 13 components included age, sex, chronic lung disease, congenital heart disease, congestive heart failure, coronary artery disease, diabetes mellitus, end stage liver disease, end stage renal disease, hypertension, immune compromised, nursing home resident, and pregnant. Univariate analysis showed all components, except pregnancy, have significant (P < .001) association with admission. The Mayo Clinic COVID-19 risk score showed a Receiver Operating Characteristic Area Under Curve (AUC) of 0.837 for the prediction of admission for this large cohort of COVID-19 positive patients.The Mayo Clinic COVID-19 risk score is a simple score that is easily integrated into the EHR with excellent predictive performance for severe COVID-19. It can be leveraged to stratify risk for severe COVID-19 at initial contact, when considering therapeutics or in the allocation of vaccine supply.

  View details for DOI 10.1177/21501319211069748

  View details for PubMedID 35068257

  View details for PubMedCentralID PMC8796071

• Electronic Vaping Product Use among Young Adults Who Receive Care at a Major Medical Institution. Substance use & misuse Sharma, P., Philpot, L. M., Rosedahl, J. K., Jose, T. T., Ebbert, J. O. 2021; 56 (2): 224-237

  Abstract

  Background: National estimates of electronic vaping product (EVP) use exist, but little is known about young adult EVP users who interact with the healthcare setting. Methods: Cross-sectional survey of 18-25 year olds receiving care in our ambulatory medical practice. Population differences were evaluated with the chi square test reporting unadjusted odds ratios (ORs). Results: Response rate was 16.6% (n = 1,017/6,119). The prevalence of ever EVP use was 46.0% of whom 13.9% used every day. Each additional day of alcohol use (past 30 days) was associated with increased odds of being an EVP user (OR = 1.06, 95% CI 1.02-1.09), and cannabis use (past 30 days) was associated with a higher odds of being an EVP user compared to non-cannabis users (OR = 40.0, 95% CI 17.4 - 111.8). Observing a biological parent (OR = 2.89, 95% CI 1.98-4.24), step parent (OR = 2.03, 95% CI 1.02-4.19) and full sibling (OR = 2.31, 95% CI 1.78-3.00) using inhaled substances (past 30 days) was associated with increased odds of being an ever EVP user. Ever EVP users had lower odds than never users to report that EVPs with nicotine are "a little" or "a lot" more harmful than smoking "regular" tobacco cigarettes (OR = 0.53, 95% CI 0.37 - 0.76). Conclusion: Our survey is limited by a low response rate but confirms observed associations between EVP use and substance use and social influences. Our data also suggest that professionals should regularly screen for EVP use among young people, especially those with exposure to family members who used inhaled substances.

  View details for DOI 10.1080/10826084.2020.1853777

  View details for PubMedID 33356754

• Sustainability of Tobacco Treatment Programs in the Cancer Center Cessation Initiative JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Salloum, R. G., Fleisher, L., Hohl, S. D., Clark, S. V., Klass, E., Dahl, N. A., Pike, B., Lenhoff, K. L., Presant, C. A., Shoenbill, K. A., Ramsey, A. T., Jose, T., Day, A. T., Dark, M., Yeung, S., Tong, E. K., Prochaska, J. J., Ostroff, J. S., Shelley, D., Warren, G. W., Adsit, R., Minion, M., Pauk, D., Rolland, B., Canc Ctr Cessation Initiative Sus 2021; 19: S16-S20

  Abstract

  The NCI's Cancer Center Cessation Initiative (C3I) has a specific objective of helping cancer centers develop and implement sustainable programs to routinely address tobacco cessation with patients. Sustaining tobacco treatment programs requires the maintenance of (1) core program components, (2) ongoing implementation strategies, and (3) program outcomes evaluation. NCI funding of C3I included a commitment of resources toward sustainability. This article presents case studies to illustrate key strategies in developing sustainability capacity across 4 C3I-funded sites. Case studies are organized according to the domains of sustainability capacity defined in the Clinical Sustainability Assessment Tool (CSAT). We also describe the C3I Sustainability Working Group agenda to make scientific and practical contributions in 3 areas: (1) demonstrating the value of tobacco use treatment in cancer care, (2) identifying implementation strategies to support sustainability, and (3) providing evidence to inform policy changes that support the prioritization and financing of tobacco use treatment. By advancing this agenda, the Sustainability Working Group can play an active role in advancing and disseminating knowledge for tobacco treatment program sustainability to assist cancer care organizations in addressing tobacco use by patients with cancer within and beyond C3I.

  View details for DOI 10.6004/jnccn.2021.7093

  View details for Web of Science ID 001051691000005

  View details for PubMedID 34872053

  View details for PubMedCentralID PMC9036976

• Implementation Science to Improve Tobacco Cessation Services in Oncology Care. Journal of the National Comprehensive Cancer Network : JNCCN 2021; 19 (Suppl_1): S12-S15

  Abstract

  Every patient with cancer deserves access to evidence-based tobacco cessation interventions as part of their routine oncology care. The NCI Cancer Moonshot funded the Cancer Center Cessation Initiative (C3I) to help establish and/or expand tobacco treatment programs at 52 NCI-designated Cancer Centers. Although this initiative has broadened the availability of tobacco treatment services across US cancer centers, the reach and utilization of these services remains low among patients. To help address the remaining gap between the availability and utilization of evidence-based treatments for tobacco use in the oncologic context, staff and investigators at C3I sites and the C3I Coordinating Center formed the C3I Implementation Science Working Group. The mission of this working group is to bring together clinicians, scientists, and policymakers who share a common interest in implementation science and treating tobacco use in the oncologic context to collaborate on projects aimed at shrinking the practice gap in this area. Through case study examples, we describe how the C3I Implementation Science Working Group is supporting efforts to identify effective ways to increase the utilization of evidence-based tobacco treatments within cancer treatment settings and promote the broader impact and long-term sustainability of C3I.

  View details for DOI 10.6004/jnccn.2021.7094

  View details for PubMedID 34872048

  View details for PubMedCentralID PMC9047055

• Electronic Cigarette Use Is Not Associated with COVID-19 Diagnosis. Journal of primary care & community health Jose, T., Croghan, I. T., Hays, J. T., Schroeder, D. R., Warner, D. O. 2021; 12: 21501327211024391

  Abstract

  This analysis tested the hypothesis that current e-cigarette use was associated with an increased risk of SARS-CoV-2 infection in patients seeking medical care. E-cigarette and conventional cigarette use were ascertained using a novel electronic health record tool, and COVID-19 diagnosis was ascertained by a validated institutional registry. Logistic regression models were fit to assess whether current e-cigarette use was associated with an increased risk of COVID-19 diagnosis. A total of 69,264 patients who were over the age of 12 years, smoked cigarettes or vaped, and were sought medical care at Mayo Clinic between September 15, 2019 and November 30, 2020 were included. The average age was 51.5 years, 62.1% were females and 86.3% were white; 11.1% were currently smoking cigarettes or using e-cigarettes and 5.1% tested positive for SARS-CoV-2. Patients who used only e-cigarettes were not more likely to have a COVID-19 diagnosis (OR 0.93 [0.69-1.25], P = .628), whereas those who used only cigarettes had a decreased risk (OR 0.43 [0.35-0.53], P < .001). The OR for dual users fell between these 2 values (OR 0.67 [0.49-0.92], P = .013). Although e-cigarettes have the well-documented potential for harm, they do not appear to increase susceptibility to SARS-CoV-2 infection. This result suggests the hypothesis that any beneficial effects of conventional cigarette smoking on susceptibility are not mediated by nicotine.

  View details for DOI 10.1177/21501327211024391

  View details for PubMedID 34109870

  View details for PubMedCentralID PMC8202250

• Digital Health Surveillance Strategies for Management of Coronavirus Disease 2019. Mayo Clinic proceedings. Innovations, quality & outcomes Jose, T., Warner, D. O., O'Horo, J. C., Peters, S. G., Chaudhry, R., Binnicker, M. J., Burger, C. D. 2021; 5 (1): 109-117

  Abstract

  To describe the design, implementation, and utilization of electronic health record (EHR)-based digital health surveillance strategies used to manage the coronavirus disease 2019 (COVID-19) pandemic and to ensure delivery of high-quality clinical care, such as case identification, remote monitoring, telemedicine services, and recruitment to clinical trials at Mayo Clinic.The design and implementation work described in this report was performed at Mayo Clinic, a large multistate integrated health care system with more than 1.5 million annual patient visits that uses the Epic EHR system. Rule-based live registries were designed in the EHR system to classify patients who currently test positive for COVID-19, patients who test positive but have recovered from COVID-19, patients who are thought to have COVID-19 but do not yet meet clinical diagnostic criteria, patients who test negative for COVID-19, and patients who exceed a risk score for serious complications from COVID-19.By use of registries, custom dashboards and operational reports were developed to provide a daily high-level summary for clinical practice use and up-to-date information to manage individual patients affected by COVID-19, including support of case identification, contact isolation, and other care management tasks.We developed and implemented a systematic approach to the use of EHR patient registries to manage the COVID-19 pandemic that proved feasible and useful in a large multistate group clinical practice. The key to harnessing the potential of digital surveillance tools to promote patient-centered care during the COVID-19 pandemic was to use the registry data, reports, and dashboards as informatics tools to inform decision-making.

  View details for DOI 10.1016/j.mayocpiqo.2020.12.004

  View details for PubMedID 33521582

  View details for PubMedCentralID PMC7831529

• Improved Documentation of Electronic Cigarette Use in an Electronic Health Record. International journal of environmental research and public health Jose, T., Hays, J. T., Warner, D. O. 2020; 17 (16)

  Abstract

  The use of electronic cigarettes (e-cigarettes) can affect patient health and clinical care. However, the current documentation of e-cigarette use in the electronic health records (EHR) is inconsistent. This report outlines how the ambulatory clinical practices of a large U.S. hospital system optimized its electronic health records (EHR) framework to better record e-cigarettes used by patients. The new EHR section for e-cigarette information was implemented for outpatient appointments. During a 30-week evaluation period post-implementation, 638,804 patients (12 yrs and older) completed ambulatory appointments within the health system; of these, the new section contained e-cigarette use information for 37,906 (6%) patients. Among these patients, 1005 (2.7%) were identified as current e-cigarette users (current every day or current some day e-cigarette use), 941 (2.5%) were reported as former e-cigarette users, and 35,960 (94%) had never used e-cigarettes. A separate EHR section to document e-cigarette use is feasible within existing clinical practice models. Utilization of the new section was modest in routine clinical practice, indicating the need for more intensive implementation strategies that emphasize the health effects of e-cigarette use, and how consistent ascertainment could improve clinical practice.

  View details for DOI 10.3390/ijerph17165908

  View details for PubMedID 32823985

  View details for PubMedCentralID PMC7460036

• Design and Pilot Implementation of an Electronic Health Record-Based System to Automatically Refer Cancer Patients to Tobacco Use Treatment. International journal of environmental research and public health Jose, T., Ohde, J. W., Hays, J. T., Burke, M. V., Warner, D. O. 2020; 17 (11)

  Abstract

  Continued tobacco use after cancer diagnosis is detrimental to treatment and survivorship. The current reach of evidence-based tobacco treatments in cancer patients is low. As a part of the National Cancer Institute Cancer Center Cessation Initiative, the Mayo Clinic Cancer Center designed an electronic health record (EHR, Epic©)-based process to automatically refer ambulatory oncology patients to tobacco use treatment, regardless of intent to cease tobacco use("opt out"). The referral and patient scheduling, accomplished through a best practice advisory (BPA) directed to staff who room patients, does not require a co-signature from clinicians. This process was piloted for a six-week period starting in July of 2019 at the Division of Medical Oncology, Mayo Clinic, Rochester, MN. All oncology patients who were tobacco users were referred for tobacco treatment by the rooming staff (n = 210). Of these, 150 (71%) had a tobacco treatment appointment scheduled, and 25 (17%) completed their appointment. We conclude that an EHR-based "opt-out" approach to refer patients to tobacco dependence treatment that does not require active involvement by clinicians is feasible within the oncology clinical practice. Further work is needed to increase the proportion of scheduled patients who attend their appointments.

  View details for DOI 10.3390/ijerph17114054

  View details for PubMedID 32517176

  View details for PubMedCentralID PMC7312526

• Feasibility of Nurse-Managed Tobacco Use Interventions in Outpatient Surgical Practice. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses Jose, T., McNamara, M., Barrone, M. L., Johnson, W. S., Larsen, H. A., Martin, E. E., Marienau, M. S., Judd, M. A., Warner, D. O. 2020; 35 (3): 307-313.e1

  Abstract

  The aim of this study was to determine the feasibility of developing and implementing a brief nurse-delivered tobacco intervention in an outpatient surgical practice.Initial formative work used a survey and focus groups to determine knowledge, attitudes, and practices of perioperative nurses working in three outpatient surgical practices regarding smoking use and cessation. Based on this work, a brief intervention was designed and implemented in one of the three practices. The documentation of tobacco use and intervention elements was assessed both immediately and approximately 9 months after implementation.Formative work identified not only several barriers to implementation and little current activity but also favorable attitudes toward interventions. Implementation improved self-efficacy for intervention delivery and compliance with documentation of intervention elements that was sustained for at least 9 months.Our results suggest that it is feasible for perioperative nurses to play an important role in the delivery of perioperative tobacco interventions.

  View details for DOI 10.1016/j.jopan.2019.10.009

  View details for PubMedID 32005603