KICKS BUTT!

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KICKS BUTT!. Tim McAfee, MD, MPH tim.mcafee@freeclear.com Clinical & Behavioral Sciences Free & Clear 206-876-2551. THE GROUP HEALTH STORY. 1991 report: Decreasing Tobacco Use at Group Health During the 1990s. - PowerPoint PPT Presentation

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  • THE GROUP HEALTH STORY

  • 1991 report: Decreasing Tobacco Use at Group Health During the 1990sGoal: Decrease the prevalence of tobacco use at Group Health by 50% from 1985 level of 25% to 12.5% by the year 2000

    Authors:Sue CurrySallie DaceyDoug LouieTim McAfeeNeal SofianLarry Ziedman

  • 1991 report: Decreasing Tobacco Use at Group Health During the 1990sObjective: A comprehensive coordinated set of interventions will be available at Group Health covering all the stages of tobacco useKey Partners:Tracy OrleansNCI & CDC OSHMichael Fiore/USPHS GL group/ATMCEd Wagner & Sue Curry (CHS)Robert S. Thompson (DPC)Bill Beery & Anne Smith (CHP)

    Key PartnersPhil Nudelman/Cheryl Scott /Scott Armstrong (CEOs)Al Truscott/Louise Liang/ Hugh Straley (Med. Directors)Jim Truess (CFO)Hundreds of VPs, managers and directorsThousands of physicians, nurses, MAs, pharmacists, etcTens of thousands of patients

  • Adult Smoking Prevalence:

  • 1991 - COP report: 7 Strategies1)Identify, track and treat tobacco use with the same vigor as other diseases with significant morbidity and mortality2)Advocate for coverage of tobacco services where clinical effectiveness has been convincingly established 3) Encourage adolescents to never become tobacco users, both during clinic contacts and through school and community outreach4)Encourage and support population-based projects to decrease tobacco use5)Make tobacco a top lobbying priority of the GHC legislative affairs office6) Develop educational programs about tobacco use and services for staff at all levels, including nursing, physician, clerical, medical assistant and pharmacy. Encourage and support on-going programs to decrease the prevalence of tobacco use among employees

    7)Treat coverage for smokers in the same manner we treat coverage for other individuals with significant chronic diseases

  • Elements of comprehensive approach Reliance upon evidenceIdentifying tobacco users in primary careTraining practice teams in brief adviceReferral to phone and group programsCoverage for counseling & medicationsIntegration with Prevention, Quality & Chronic Care initiativesSupport for community policy change

  • Health system opportunity:

  • SMOKE-FREE FITS GHC MISSIONFits GHCs preventive care and health promotion mission

    Supported by marketing and communications

    Issue of quarterly member magazine

  • Top take-home lessons

    Science is a good starting placeIts a product, marketing and sales challenge!Hold on to the tigers tailPeople, systems, and measurement make a differenceDesign for end-usersAdviseAskRefer

  • Research CollaborationsNEngJMed 9/3/98 339:673-679 Curry et al

  • Primary care: tobacco status identification on all charts* > 85% in all 29 primary care clinics

  • Provider advice to smokers*p
  • Documentation of Patient Tobacco Status using the TRF:TOBACCO USE STATUS(circle one)

    Non-Tobacco user4Current Tobacco User1Recent Quitter

  • TRF Tobacco status identification:

  • Cessation Program Quality ImprovementWhy: Excellent program, but little impact due to low reach(in 1992 only 180 participants/year)

    Difficult to sustain clinic-based assistance/follow-up

    EMBED Word.Picture.6

  • Free & Clear improvementsRemoval of financial barriersIntegrated pharmacotherapy:program assesses, generates Rxindividualized ensures follow-up receivedStrong quality controls/reportingPromotional support

  • Free & Clear ParticipationGroup Health EnrolleesOne-year quit rate: 25-30% (30-day abstinence ~ Intent-to-Treat)

  • Policy/population tobacco effortsNW Health articlesSmoke-free campusesMaster Settlement Agreement Seattle Times ad banLabor and Industry worksite banAccess/merchant fee billDefeating Smokers Rights billTestimony/op-ed piecesPassage of two state initiativesFree & Clear external & state quit lines

  • I 773 and I-901I-773 2001 WA state initiativeRaised tax on pack of cigarettes 60 cents Guarantees 26 million to Tobacco Control

    I-901 2005 Clean Indoor Air 100% ban

    GHC Board endorsed, contributed $$, & lobbyist/staff time for both

  • To serve the greatest number

  • Free & Clear Participation Ratesper 1000(Note: 2004 rates annualized based on first 2 quarters)

    Chart1

    7.644994499

    8.147914791

    847214721

    6.435693569

    5.930973097

    F& C Enrollment per 1,000

    4,791

    4,499

    3,097

    4,721

    3,569

    n

    Sheet1

    20007.64499

    20018.14791

    20028.04721

    20036.43569

    20045.93097

    Sheet2

    Sheet3

  • Smoking Prevalence 2003by GHC Delivery System

    (Data Source: CAHPS Adult Survey 2002-2004)Commercially Insured Adults aged 18-65 years

    Plan

    nEstimate95%CI

    Traditional HMOYearSample%95%CI

    19981,24014%12.1%15.9%1998~1,24014.0(12.1,15.9)

    19991,24015%13.0%17.0%1999~1,24015.0(13.0,17.0)

    20002000

    20012001

    All200200.12202380950.08702525630.157022362720012,06413.8(12.3,15.2)

    Products20033100.12903225810.09171365240.166350863720022,09111.4(10.0,12.7)

    20043530.14730878190.11033627210.184281291720031,91914.7(13.1,16.3)

    HMO20029180.14379084970.12109270870.1664889906200191814.4(12.1,16.6)

    20039100.12527472530.10376658090.1467828696200291012.5(10.4,14.7)

    20048210.15347137640.12881558140.1781271714200382115.3(12.9,17.8)

    Alliant20025620.13167259790.10371644740.1596287483200156213.2(10.4,16.0)

    20035810.10154905340.07698765270.126110454200258110.2(7.7,12.6)

    20045230.13962264150.1101145890.1691306941200352314.0(11.0,16.9)

    Options20025840.13356164380.10597115720.1611521305200158413.4(10.6,16.1)

    20036000.10833333330.08346407890.1332025877200260010.8(8.3,13.3)

    20045680.14436619720.11546215190.1732702424200356814.4(11.5,17.3)

    Total200220640.13759689920.12273546570.152458332720022,06413.8(12.3,15.2)

    GHC200320910.11382113820.10020822080.127434055620032,09111.4(10.0,12.7)

    200419190.14695153730.13111017580.162792898720041,91914.7(13.1,16.3)

    19981,24014%12.1%15.9%

    19991,24015%13.0%17.0%

    2000

    2001

    20021100.12727272730.06499013530.1895553192

    20031000.170.09637597130.2436240287

    20041140.14035087720.07658742480.2041143296

    Division

    CNCSDIGP

    PlansSample%95%CISample%95%CI

    HMO15712.1(7.0,17.2)66416.1(13.3,18.9)

    Alliant4723.4(11.3,35.5)48313.0(10.0,16.0)

    Options24814.5(10.1,18.9)32014.4(10.5,18.2)

    Total45214.6(11.3,16.4)1,46714.7(12.9,16.5)

    Age

    200120022003

    Age Groupn%95%CIn%95%CIn%95%CITotalExpectedRateULLLTotalExpectedRateTotalExpectedRate

    18 to 3433612.2(8.7,15.7)31012.9(9.2,16.6)35314.7(11.0,18.4)18 to 343364131043.354838709735349.4957507082

    35 to 4449813.1(10.1,16.0)47310.6(7.8,13.3)35814.8(11.1,18.5)35 to 444986547352.642706131135873.7262569832

    45 to 5469516.8(14.1,19.6)67411.4(9.0,13.8)52116.1(13.0,19.3)45 to 5469511767479.3991097923521112.0537428023

    55 to 6449111.4(8.6,14.2)56211.0(8.4,13.6)58913.8(11.0,16.5)55 to 644915656254.167259786558967.5229202037

    Total (crude)2,02013.8(12.3,15.3)2,01911.3(10.0,12.7)1,82114.8(13.2,16.5)Total (Crude)2,0202790.13811881190.12307248460.15316513922,019229.56391441950.11364550220.09980130540.1274896991,821302.79867069750.1499003320.13350435430.1662963097

    Total (adjusted)13.8(12.3,15.3)11.4(10.0,12.7)15.0(13.4,16.6)

    Sheet2

    Total Commercial Group Health

    200220032004

    AgeGrpYesTotal%LLULYesTotal%LLULYesTotal%LLUL

    18 to 249970.09278350529720.12511650.1692307692

    25 to 34322390.1338912134312380.1302521008412880.1423611111

    18 to 344133612.2%8.7%15.7%4031012.9%9.2%16.6%5235314.7%11.0%18.4%

    35 to 446549813.1%10.1%16.0%5047310.6%7.8%13.3%5335814.8%11.1%18.5%

    45 to 5411769516.8%14.1%19.6%7767411.4%9.0%13.8%8452116.1%13.0%19.3%

    55 to 645649111.4%8.6%14.2%6256211.0%8.4%13.6%8158913.8%11.0%16.5%

    65 to 7454112.2%2.2%22.2%85315.1%5.5%24.7%106016.7%7.2%26.1%

    75 or older030.0%0.0%0.0%1520.0%-15.1%55.1%1147.1%-6.3%20.6%

    65+54411.4%2.0%20.7%95815.5%6.2%24.8%117414.9%6.8%23.0%

    Total284206413.8%12.3%15.2%238207711.5%10.1%12.8%281189514.8%13.2%16.4%

    Total (-65)279202013.8%12.3%15.3%229201911.3%10.0%12.7%270182114.8%13.2%16.5%

    Sys Del

    CNCSNANANANANA4440210.9%7.9%14.0%6645214.6%11.3%17.9%

    IGPNANANANANA194168911.5%10.0%13.0%216146714.7%12.9%16.5%

    Total284206413.8%12.3%15.2%238209111.4%10.0%12.7%282191914.7%13.1%16.3%

    HMO

    200220032004

    AgeGrpYesTotal%LLULYesTotal%LLULYesTotal%LLUL

    18 to 243510.05882352943470.06382978727340.2058823529

    25 to 3413960.135416666713940.138297872318960.1875

    18 to 341614710.9%5.8%15.9%1614111.3%6.1%16.6%2513019.2%12.5%26.0%

    35 to 443021813.8%9.2%18.3%2619213.5%8.7%18.4%1812614.3%8.2%20.4%

    45 to 545731118.3%14.0%22.6%4130413.5%9.6%17.3%3621217.0%11.9%22.0%

    55 to 642721412.6%8.2%17.1%2623711.0%7.0%14.9%4329814.4%10.4%18.4%

    65 to 742267.7%-2.6%17.9%42615.4%1.5%29.3%3329.4%-0.7%19.5%

    75 or older020.0%0.0%0.0%1425.0%-17.4%67.4%1137.7%-6.8%22.2%

    65+2287.1%-2.4%16.7%53016.7%3.3%30.0%4458.9%0.6%17.2%

    Total13291814.4%12.1%16.6%11490412.6%10.4%14.8%12681115.5%13.0%18.0%

    Sys Del

    CNCSNANANANANA3227711.6%7.8%15.3%1915712.1%7.0%17.2%

    IGPNANANANANA8263313.0%10.3%15.6%10766416.1%13.3%18.9%

    Total13291814.4%12.1%16.6%11491012.5%10.4%14.7%12682115.3%12.9%17.8%

    ALLIANT

    200220032004

    AgeGrpYesTotal%LLULYesTotal%LLULYesTotal%LLUL

    18 to 242170.11764705881110.09090909091140.0714285714

    25 to 349620.14516129036580.103448275910950.1052631579

    18