1. Engaging the Participants: Evidence- Based Strategies and Interventions Mabruk Quabili, BS, MPH Health Informatics Specialist Health Services Advisory Group (HSAG)

2. Trans-Theoretical Model: Stages of Change 2 Source: Prochaska, J. O. & Di Clemente, C. C., (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19(3), 276-288. Figure 2, p. 283. Precontemplation Relapse can occur at any time. Contemplation Preparation Action Maintenance Termination is the goal. No recognition of need for or interest in change Thinking about change Planning for change Adopting new habits Ongoing practice of new, healthier behavior

3. Motivational Interviewing: Primary Skills Express empathy Develop discrepancy Avoid argumentation Roll with resistance Support self-efficacy 3

4. Motivational Interviewing: Other Skills Open-ended questions Assess readiness Reflective listening Case Western Reserve University – Am I Doing This Right? http://www.centerforebp.case.edu/ client-files/pdf/miremindercard.pdf – Readiness/Importance Ruler http://www.centerforebp.case.edu/ client-files/pdf/readinessruler.pdf 4

5. Motivational Interviewing: Frames 5 Feedback: Personalized information Responsibility: Freedom of choice Advice: Need for change Menu: Strategies for change Empathy: Supportive, reflective style Self-efficacy: Participant belief

6. Centers for Medicare & Medicaid Services (CMS) Definitions Effective for services on or after January 1, 2008: – Smoking and tobacco-use cessation counseling visit; intermediate, greater than three minutes and up to ten minutes OR – Smoking and tobacco-use cessation counseling visit; intensive, greater than ten minutes 6 Source: CMS MLN Matters; http://www.cms.gov/Outreach-and-Education/Medicare-Learning- Network-MLN/MLNMattersArticles/downloads/mm5878.pdf

7. Brief Provider Motivation Tips: The Five R’s of Enhancing Motivation 7 Relevance to them personally Risk of their use Rewards gained from smoking cessation Roadblocks or barriers Repetition during each visit

8. Brief Provider Cessation Tips: The Five A’s of Tobacco Cessation 8 Ask about tobacco use Advise patient to quit Assess readiness to quit Assist patient with their quit attempt – Set a target date, Tell family and friends, Anticipate challenges, Remove tobacco products (STAR) Arrange follow-up encounters

9. Thank you! Mabruk Quabili, BS, MPH HSAG Health Informatics Specialist 614.301.3902

10. This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Ohio, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. OH-11SOW-B.1 06092015-02