Integrating cancer risk reduction into primary care: A resident-led tobacco cessation quality improvement project.

499 Background: Cigarette smoking accounts for nearly 20% of all cancer cases and 30% of cancer-related deaths in the U.S., making it the leading preventable cause of cancer. Despite evidence-based guidelines, smoking cessation interventions are inconsistently implemented, especially in training environments. In this study, we evaluated the impact of a resident-led smoking cessation protocol in a recently established internal medicine residency clinic. Methods: A retrospective chart review was conducted of adult patients (≥18 years) identified as current smokers during ambulatory visits at our internal medicine residency clinic between April 1, 2024, and May 31, 2025. Pre-intervention data were collected from April to September 2024. Post-intervention data were collected across two Plan-Do-Study-Act (PDSA) cycles from December 2024 to May 2025. Interventions in Cycle 1 included a resident-led educational lecture, integration of a SmartPhrase (.QUITSMOKING) into the electronic health record (EHR), and placement of educational posters in the clinic. Cycle 2 focused on workflow integration and reinforcement strategies, including use of a medical assistant-administered tobacco screening form and regular reminders to residents via email and clinic huddles. Data were analyzed using descriptive statistics and Chi-Squared tests. A p-value <0.05 was considered statistically significant. Results: A total of 237 current smokers were included in the analysis: 131 patients in the pre-intervention period and 106 in the post-intervention period (47 during PDSA Cycle 1 and 59 during Cycle 2). In the pre-intervention period, 42 patients (32.06%) received documented smoking cessation counseling and 24 (18.32%) were prescribed cessation medications. In the post-intervention period, 61 patients (57.55%) received counseling and 53 (50.00%) received prescriptions, representing significant improvements in both counseling (p = 0.00014) and prescribing rates (p < 0.000001). Counseling rates increased from 53.19% in Cycle 1 to 61.02% in Cycle 2, while prescribing rates increased from 46.81% to 52.54%. These findings support the efficacy of targeted, system-based interventions in improving delivery of smoking cessation services in a recently established residency training environment. Conclusions: A structured smoking cessation protocol significantly improved counseling and prescribing rates in our residency clinic. Low-resource, workflow-integrated interventions are effective in advancing cancer preventive care delivery in academic training settings. Comparison of smoking cessation counseling and prescription rates before and after intervention. Quality Measure Pre-Intervention (n=131) Post-Intervention (n=106) p-value Received Smoking Cessation Counseling 42 (32.06%) 61 (57.55%) 0.00014 Prescribed Smoking Cessation Medications 24 (18.32%) 53 (50.00%) <0.000001