Lezli Redmond, MPH Director Statewide Outreach Programs Assistant Director, UW-CTRI Disseminating Best Practices: Tobacco Dependence Treatment in Wisconsin Wednesday, January 27, 2010 NIATx Meeting Orlando

Goals Describe the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) and the Outreach Program Describe our experience with the “how to” of disseminating best practices across a state Discuss a national collaborative that serves as a learning community to support our work Outline challenges and future plans

Advancing Tobacco Treatment Science at UW-CTRI Established in 1992 Lead UW-Madison entity charged with reducing the harms from tobacco use Research focuses on counseling, medications and health system changes to help smokers quit $50 million in external grant funding over 15 years (primarily NIH)

Three Successive NIH P50 Center Grants Relapse: Linking Science and Practice$10 million Tobacco Dependence: Treatment and Outcomes $9 million Engineering Effective Interventions for Tobacco Use: A Translational Laboratory $9 million

United States Public Health Service (PHS) Guidelines Initial Guideline published Literature from Approx. 3,000 articles Revised Guideline published Literature from Approx. 6,000 articles Updated Guideline published Literature from 1975 – 2007 Approx. 8,700 total articles

UW-CTRI Cessation Outreach Programs

UW-CTRI Cessation Outreach Program ●Train primary care clinicians and other clinic staff ●Provide technical assistance on systems change to integrate evidence-based tobacco dependence treatment into healthcare delivery systems ●Reduce barriers to tobacco dependence treatment ●Increase insurance coverage for treatment ●Integrate the Wisconsin Tobacco Quit Line

Some Process Outcomes Trained over 10,000 clinicians and clinic staff Provided on-site training and technical assistance to 920 clinics and hospitals; 26 healthcare systems in Wisconsin Over 31,000 clinicians earned CME/CE The UW-CTRI website averages over 2,000,000 hits per year with over 2,000 unique visitors each week More than 150,000 callers to Wisconsin Tobacco Quit Line; 110,000 received treatment services (~15% of Wisconsin Smokers) Approximately 20% of callers referred by clinicians, 10,000 came in through Fax to Quit Integrated tobacco dependence treatment with EMRs at four health systems and several hospitals Insurance coverage for tobacco dependence treatment increased significantly

Long-term Outcomes Increased quit attempts and decreased smoking rates – Smokers making serious quit attempts went from 46% in 2003 to 59% in Nationally the rate stayed at approximately 45%. – Between 2001 and 2007 adult tobacco use rates decreased from 24% to 19.7%.

Dissemination vs. Diffusion Dissemination is active rather than passive It’s a collaborative process An organization must be “ready” and have the capacity to make the change Involves formal and informal leaders at all levels of the organization

Active Dissemination Methods Train the trainer Media campaigns Educating opinion leaders Collaborative planning (take them where they’re at and work from there) Encourage systems-level change implementation

Disseminating Innovations in Health Care Find sound innovations Find and support “innovators” Invest in “early adopters” Trust and enable “reinvention” Make early adopter activity observable Donald Berwick, MD, MPP 2003

Levers For Change Partnerships (consistent messages; follow through; commitment; in it for the long haul) Leadership (champions on all levels; tobacco dependence can be treated successfully; we will show you how; everyone can save money and do the right thing) Innovations (be a leader; demonstrate success; HMOs competitive; connection with state-of-the art tobacco dependence treatment) Finances (cost-saving, return on investment)

Tobacco Treatment is a Team Effort

UW-CTRI Outreach Lessons 1. Continue to make the “why” compelling and the “how” clear, do-able and tailored 2. “Spread” requires social interaction and constant, multi-faceted communications 3. Recognize, cultivate and celebrate champions and successful organizations 4. Use a systems approach 5. Demonstrate results and provide feedback

Why and How? for clinicians It’s the most important thing you can do for the health of your patient It will only take a few minutes of your time It’s effective We’ll show you and your colleagues how, and give you scripts for exactly what to say

Why and How? for Administrators Per member per month (PMPM) cost for tobacco dependence treatment $0.20 to $0.80 PMPM America’s Health Insurance Plans (AHIP) and the Center for Health Research (CHR) demonstrated that investments in smoking cessation save money It’s effective and evidence-based We’ll provide valuable resources to help you do this (technical assistance and experience)

“Spread” Requires Social Interaction Face-to-face best but not always possible Supplement with website, , distance learning, new technologies Obtain communications expertise if possible Present (or have successful innovators present) at conferences

“Spread” via Partnerships Who could have a stake in the change? – Professional organizations – Quality improvement groups – Policy-makers – Coalitions – Provider groups and networks – Other networks, formal and informal – Client groups

Help Partners Tell Their Stories

Create or Join a Learning Community Mission: Facilitate sustainable changes in health care systems to reduce tobacco use and prevalence Methods: Share knowledge and practices, document emerging and best practices at the state level, work with national partners for national change

Use A Systems Approach Typically, interventions target smokers or clinicians Systems-level approaches implemented throughout the healthcare delivery system Strategies ensure tobacco use is systematically addressed and treated at every clinical encounter, creating a new standard of care Power of “institutionalizing” treatment of tobacco dependence

Systems Thinking Small events can create large changes in complex systems

Why A Systems Approach? Efforts directed only to tobacco users have been disappointing and expensive Efforts directed only to healthcare providers not sufficient Population-based is the key We want to make BIG changes that are sustainable and integral We can NOT create change alone

Results and Feedback With a best practice you don’t need to “prove” effectiveness Data is critical though often hard to collect Data can take you from “adoption” to full implementation Quality improvement staff can help Feedback is powerful and can change individual and organizational behavior

Challenges to UW-CTRI Outreach Funding cuts to our program and overall tobacco control Less ability to do face-to-face academic detailing Loss of “champions” Less political support (other priorities) Sustainability

Future for UW-CTRI Outreach More emphasis on systems change rather than individual clinics More use of distance learning and use of new technologies Take advantage of new opportunities for widespread change such as electronic medical records Strategically reach out to formal leadership Development of Wisconsin Health Systems for Cessation Collaborative