Rational, aims & objectives: The goal of this observational study was to compare three referral methods and determine which led to the highest utilization of the Duke Smoking Cessation Program (DSCP). Materials & methods: We conducted two assessments within the Duke health system: a 12-month assessment of Traditional Referral (a provider refers a patient during a patient visit) and Best Practice Advisory (BPA) (a provider refers a patient after responding to an alert within the electronic health record); and a 30-day assessment of Population Outreach (a list of smokers is generated through the electronic health record and patients are contacted directly). Results: Over the 12-month assessment, a total of 13,586 smokers were seen throughout health system clinics receiving services from the DSCP. During this period, the service utilization rate was significantly higher for Traditional Referral (3.8%) than for BPA (0.6%); p < 0.005. The 30-day pilot assessment of showed a service utilization rate for Population Outreach of 6.3%, significantly higher than Traditional Referral (3.8%); p < 0.005 and BPA (0.6%; p < 0.005). Conclusion: Population Outreach appears to be an effective referral method for increasing utilization of the DSCP.