Zwaga Investigates How Providers Differ in Treating Patients’ Tobacco Use

Deejay Zwaga
Deejay Zwaga

Even with training and support, healthcare providers vary markedly in how they address smoking by their patients. New approaches are needed to help them.

UW-CTRI Biostatistical Analyst Deejay Zwaga is studying exactly that. It’s thanks to the diversity grant program from the National Cancer Center, a supplement to the R35 Grant held by UW-CTRI Director Dr. Michael Fiore in partnership with Group Health Cooperative of South Central Wisconsin (GHC).

Zwaga aims to track, identify and analyze the different ways providers in a healthcare system treat tobacco use. One might think that, once a prompt is built into a system’s electronic health record (EHR), treatment would be uniform across providers and patients.

But in the parent R35 project, known as the Comprehensive Chronic Care Smoking Treatment System (CCCSTS) Implementation Project at GHC, it turns out that’s not the case. There are differences between providers and clinics within the system in terms of how they offer cessation counseling, pharmacotherapy and referrals to in-house Tobacco Cessation Outreach Specialists.

This is despite the best intentions of all parties to form a proactive chronic-care approach to help patients live tobacco-free.

Zwaga is working with her primary mentors for the grant—UW-CTRI Researchers Dr. Danielle McCarthy, Dr. Marlon Mundt and Fiore—to better understand this variance between primary-care providers (PCP), develop better ways to analyze it and seek to improve it. They’ll examine three key factors:

  1. The provider-patient relationship.
  2. Provider referrals to Tobacco Cessation Outreach Specialists, and patient interaction with those specialists.
  3. Cost savings and treatment effectiveness.

patient and doctor in mask

At GHC, an alert appears for every patient who meets criteria for a smoking registry, prompting providers to address nicotine addiction. In the interactive alert, the provider has the option to open an “order set” to order pharmacotherapy and refer to a Tobacco Cessation Outreach Specialist, note that counseling occurred, set a quit date with the patient, or to note if a patient declines quitting assistance. Providers who recorded responses in the EHR alert at least once will be considered adopters; those who never addressed the alert will be considered non-adopters.

Zwaga and her mentors will examine the rates at which providers intervened, and how. They’ll analyze patients’ demographics—such as insurance status, race, ethnicity, age, gender—to see if patterns develop.

“Given my interest in medicine and population health, I was interested in exploring this variability further,” Zwaga said. “It coincides with the secondary goal of the parent project: assessing staff engagement in delivering CCCSTS through aggregate patient-engagement data and through assessment of workflow.”

The researchers hope they’ll get a better feel for the investment of time, money and other resources a health system like GHC needs to invest to get the average patient to quit.

“It takes time and resources to do that successfully,” Mundt said. “It will be interesting to see how much investment is necessary to make this work.”

With this supplement, Zwaga will continue to evaluate the month-to-month progress on the R35 project.

“Embedded in this supplement are opportunities to work on a manuscript and oral presentations under the mentorship of the other scientists involved in the project,” Zwaga said, “as well as prepare for the next stage of my career.”

In addition to McCarthy, Mundt and Fiore, these mentors include UW-CTRI researchers Mark Zehner and Dr. Nayoung Kim. UW-CTRI Director of Biostatistical Operations Dr. Stevens Smith (left) also serves as Zwaga’s supervisor and general mentor.

Dr. Stevens Smith, PhD
Dr. Stevens Smith, PhD

In addition to McCarthy, Mundt and Fiore, these mentors include UW-CTRI researchers Mark Zehner and Dr. Nayoung Kim.

UW-CTRI Director of Biostatistical Operations Dr. Stevens Smith (left) serves as Zwaga’s supervisor and general mentor.

“I am very excited about this opportunity,” Zwaga said.

She plans to matriculate to medical school in fall of 2022.