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Provider-Level Variation in Smoking Cessation Assistance Provided in the Cardiology Clinics: Insights From the NCDR PINNACLE Registry
Open Access Articles
  • Mayank Sardana, University of California, San Francisco
  • Yuanyuan Tang, Mid America Heart Institute
  • Jared W. Magnani, University of Pittsburgh
  • Ira S. Ockene, University of Massachusetts Medical School
  • Jeroan J. Allison, University of Massachusetts Medical School
  • Suzanne V. Arnold, Mid America Heart Institute
  • Phillip G. Jones, Mid America Heart Institute
  • Thomas M. Maddox, Washington University
  • Salim S. Virani, Baylor University
  • David D. McManus, University of Massachusetts Medical School
UMMS Affiliation
Department of Population and Quantitative Health Sciences; Department of Medicine, Division of Cardiovascular Medicine
Publication Date
Document Type

Background: Studies show suboptimal provision of smoking cessation assistance (counseling or pharmacotherapy) for current smokers attempting to quit. We aimed to identify smoking cessation assistance patterns in US cardiology practices.

Methods and Results: Among 328 749 current smokers seen between January 1, 2013, and March 31, 2016, in 348 NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence)-affiliated cardiology practices, we measured the rates of cessation assistance. We used multivariable hierarchical logistic regression models to determine provider-, practice-, and patient-level predictors of cessation assistance. We measured provider variation in cessation assistance using median rate ratio (the likelihood that the same patient would receive the same assistance at by any given provider; > 1.2 suggests significant variation). Smoking cessation assistance was documented in only 34% of encounters. Despite adjustment of provider, practice, and patient characteristics, there was large provider-level variation in cessation assistance (median rate ratio, 6 [95% CI , 5.76-6.32]). Practice location in the South region (odds ratio [OR], 0.48 [0.37-0.63] versus West region) and rural or suburban location (OR, 0.92 [0.88-0.95] for rural; OR, 0.94 [0.91-0.97] for suburban versus urban) were associated with lower rates of cessation assistance. Similarly, older age (OR, 0.88 [0.88-0.89] per 10-year increase), diabetes mellitus (OR, 0.84 [0.82-0.87]), and atrial fibrillation (OR, 0.93 [0.91-0.96]) were associated with lower odds of receiving cessation assistance.

Conclusions: In a large contemporary US registry, only 1 in 3 smokers presenting for a cardiology visit received smoking cessation assistance. Our findings suggest the presence of a large deficit and largely idiosyncratic provider-level variation in the provision of smoking cessation assistance.

  • primary prevention,
  • quality of care,
  • registry,
  • smoking
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Copyright 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
DOI of Published Version

J Am Heart Assoc. 2019 Jul 2;8(13):e011412. doi: 10.1161/JAHA.118.011307. Epub 2019 Jun 28. Link to article on publisher's site

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Creative Commons License
Creative Commons Attribution 4.0
Citation Information
Mayank Sardana, Yuanyuan Tang, Jared W. Magnani, Ira S. Ockene, et al.. "Provider-Level Variation in Smoking Cessation Assistance Provided in the Cardiology Clinics: Insights From the NCDR PINNACLE Registry" Vol. 8 Iss. 13 (2019) ISSN: 2047-9980 (Linking)
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