TOBACCO CONTROL INITIATIVE HCSD Disease Management Program Quarterly Meeting April 26, 2005 Sarah Moody Thomas, PhD Statewide Clinical Lead

Goal: to implement and evaluate evidence-based cessation services in HCSD hospitals.

HCSD Disease Management Program Coordination of resources across the healthcare delivery system to improve disease outcomes.

Three Critical Factors for Tobacco Control Program Success Use a population-based perspective and data Use a population-based perspective and data Recognize tobacco use as key health indicator Recognize tobacco use as key health indicator Know needs of population Know needs of population Be evidence-driven Be evidence-driven Focus on needs of population Focus on needs of population Be evidence-driven Be evidence-driven

Physician Advice Media Population Based Smoking Cessation Increased Cost Restrictions on Smoking Pharmacological Therapy Comprehensive Tobacco- Control Program Smoker Quit Successful Cessation Telephone Hotlines Relapse Prevention Contemplation 1 2 3

Obtain broad organizational support Obtain broad organizational support Seek support at all levels of organization Seek support at all levels of organization Set high goals and interim objectives Set high goals and interim objectives Provide support for clinical activity Provide support for clinical activity Remove financial and organizational barriers to effective tobacco treatment Remove financial and organizational barriers to effective tobacco treatment Rigorously evaluate Rigorously evaluate Integrate tobacco control program into Integrate tobacco control program into Quality Improvement Quality Improvement Disease Management Disease Management Guideline projects Guideline projects Three Critical Factors for Tobacco Control Program Success

IMPLEMENTATION PLANNING THE 12 STEPS Healthcare Effectiveness Meeting, 4/03

Implementation Planning - 12 Steps Conduct Needs Assessment - Shared Conduct Needs Assessment - Shared Identify IT needs - Shared Identify IT needs - Shared Develop goals and objectives - Shared Develop goals and objectives - Shared Identify target population – Facility specific Identify target population – Facility specific

Implementation Planning - 12 Steps Design program evaluation - Shared Design program evaluation - Shared Develop marketing and communication plan – Shared & Facility-specific Develop marketing and communication plan – Shared & Facility-specific Assess pharmacy options – Facility specific Assess pharmacy options – Facility specific Program roll-out – Facility specific Program roll-out – Facility specific

Implementation Planning – 12 Steps Determine staff and operational needs – Shared & Facility specific Determine staff and operational needs – Shared & Facility specific Identify training needs – Facility specific Identify training needs – Facility specific Establish timeline – Shared & Facility specific Establish timeline – Shared & Facility specific Identify pilot sites – Facility specific Identify pilot sites – Facility specific

INDICATORS

Program Indicators Increase to 75%, the proportion of clinics (physicians) that refer patients to evidence-based cessation treatment. Increase to 75%, the proportion of clinics (physicians) that refer patients to evidence-based cessation treatment. Increase to 100%, the proportion of patients who are asked about tobacco use status and documented at every visit. Increase to 100%, the proportion of patients who are asked about tobacco use status and documented at every visit.

Program Indicators Increase to 90%, the proportion of patients who are advised to quit. Increase to 90%, the proportion of patients who are advised to quit. Increase to 75%, the proportion of patients using tobacco and willing to make a quit attempt who are assisted (i.e. behavioral counseling and pharmacotherapy). Increase to 75%, the proportion of patients using tobacco and willing to make a quit attempt who are assisted (i.e. behavioral counseling and pharmacotherapy).

Program Indicators Increase to 50%, the proportion of patients using tobacco who attempt to quit (i.e. receive an appointment for cessation classes), for whom follow-up contact is arranged. Increase to 50%, the proportion of patients using tobacco who attempt to quit (i.e. receive an appointment for cessation classes), for whom follow-up contact is arranged. Increase to 10%* annually the number of smokers who are trying to quit, who stay abstinent for a full year or longer. Increase to 10%* annually the number of smokers who are trying to quit, who stay abstinent for a full year or longer. *National quit rate is 6 %

Breakout Session Facility Representation Bogalusa Medical Center Bogalusa Medical Center Chabert Medical Center Chabert Medical Center Earl K. Long Medical Center Earl K. Long Medical Center Huey P. Long Medical Center Huey P. Long Medical Center Lallie Kemp Regional Medical Center Lallie Kemp Regional Medical Center Medical Center of Louisiana Medical Center of Louisiana University Medical Center University Medical Center W. O. Moss Medical Center W. O. Moss Medical Center

Improvement Strategies Breakout Session Feedback Increase attendance rates Increase attendance rates Consider alternate scheduling processes Consider alternate scheduling processes Offer multiple times Offer multiple times Increase physician support/compliance Increase physician support/compliance Engage nursing staff (nurse-friendly strategies) Engage nursing staff (nurse-friendly strategies) Continue/increase TCI Staff presence Continue/increase TCI Staff presence Prompts Prompts Posters Posters Chart indicators identifying tobacco users Chart indicators identifying tobacco users Provide patient-related feedback (cessation updates) Provide patient-related feedback (cessation updates)

Improvement Strategies Breakout Session Feedback Increase the proportion of patients advised to quit by their provider Increase the proportion of patients advised to quit by their provider Exit surveys Exit surveys Peer review Peer review Marketing Marketing Hospital Newsletters Hospital Newsletters Program Awareness Program Awareness Available classes Available classes Staff/Clinic recognition Staff/Clinic recognition Special events Special events Examine hospital policies Examine hospital policies Market employee cessation Market employee cessation

Future Directions 2005 Objectives Complete hiring and training of field staff Complete hiring and training of field staff Establish standardized database Establish standardized database Create a formal indicator system Create a formal indicator system Standardize data sources Standardize data sources Resource Scheduling Resource Scheduling Abstraction Sources Abstraction Sources Clinic forms revision Clinic forms revision Establish HCSD website presence Establish HCSD website presence