TOBACCO CONTROL INITIATIVETOBACCO CONTROL INITIATIVE

HCSD Disease Management ProgramHCSD Disease Management Program

Quarterly MeetingQuarterly Meeting

April 26, 2005April 26, 2005

Sarah Moody Thomas, PhDSarah Moody Thomas, PhD

Statewide Clinical LeadStatewide Clinical Lead

Goal:Goal: to implement to implement and and

evaluate evidence-evaluate evidence-based based

cessation services incessation services in

HCSD hospitals.HCSD hospitals.

UniversityHospitalShreveport

E.A. Conway Medical CenterMonroe

Huey P. Long

Medical CenterPineville

W.O. Moss Regional Medical Center

Lake Charles

UniversityMedical Center

Lafayette

Earl K. Long Medical Center

Baton Rouge

Leonard J. Chabert

Medical CenterHouma

Medical Center ofLouisiana atNew Orleans

Lallie KempRegional

Medical CenterIndependence

BogalusaMedical Center

Bogalusa

UniversityHospitalShreveport

E.A. Conway Medical CenterMonroe

Huey P. Long

Medical CenterPineville

W.O. Moss Regional Medical Center

Lake Charles

UniversityMedical Center

Lafayette

Earl K. Long Medical Center

Baton Rouge

Leonard J. Chabert

Medical CenterHouma

Medical Center ofLouisiana atNew Orleans

Lallie KempRegional

Medical CenterIndependence

BogalusaMedical Center

Bogalusa

HCSD Disease Management ProgramHCSD Disease Management Program

Coordination of resources across the healthcare delivery system to improve disease outcomes.

Three Critical Factors for Three Critical Factors for Tobacco Control Program Tobacco Control Program

SuccessSuccess Use a population-based Use a population-based

perspective perspective and dataand data Recognize tobacco use as key health Recognize tobacco use as key health

indicatorindicator Know needs of populationKnow needs of population

Be evidence-drivenBe evidence-driven Focus on needs of populationFocus on needs of population

Be evidence-drivenBe evidence-driven

Physician Advice

Media

Population Based Smoking Cessation

Increased CostRestrictions on SmokingPharmacological TherapyComprehensive Tobacco-

Control Program

Smoker QuitSuccessful Cessation

Telephone Hotlines

Relapse Prevention

Contemplation

12

3

Obtain broad organizational supportObtain broad organizational support Seek support at all levels of organizationSeek support at all levels of organization Set high goals and interim objectivesSet high goals and interim objectives

Provide support for clinical activityProvide support for clinical activity Remove financial and organizational barriers to Remove financial and organizational barriers to

effective tobacco treatmenteffective tobacco treatment Rigorously evaluateRigorously evaluate Integrate tobacco control program intoIntegrate tobacco control program into

Quality ImprovementQuality Improvement Disease ManagementDisease Management Guideline projectsGuideline projects

Three Critical Factors for Three Critical Factors for Tobacco Control Program Tobacco Control Program

SuccessSuccess

IMPLEMENTATION PLANNINGIMPLEMENTATION PLANNINGTHE 12 STEPSTHE 12 STEPS

Healthcare Effectiveness Meeting, 4/03

Implementation Planning - 12 Implementation Planning - 12 StepsSteps

Conduct Needs Assessment - SharedConduct Needs Assessment - Shared

Identify IT needs - SharedIdentify IT needs - Shared

Develop goals and objectives - Develop goals and objectives - SharedShared

Identify target population – Facility Identify target population – Facility specificspecific

Implementation Planning - 12 Implementation Planning - 12 StepsSteps

Design program evaluation - SharedDesign program evaluation - Shared

Develop marketing and communication Develop marketing and communication plan – Shared & Facility-specificplan – Shared & Facility-specific

Assess pharmacy options – Facility Assess pharmacy options – Facility specificspecific

Program roll-out – Facility specificProgram roll-out – Facility specific

Implementation Planning – 12 Implementation Planning – 12 StepsSteps

Determine staff and operational needs Determine staff and operational needs – Shared & Facility specific– Shared & Facility specific

Identify training needs – Facility Identify training needs – Facility specificspecific

Establish timeline – Shared & Facility Establish timeline – Shared & Facility specificspecific

Identify pilot sites – Facility specificIdentify pilot sites – Facility specific

INDICATORSINDICATORS

Program IndicatorsProgram Indicators

Increase to 75%, the proportion of Increase to 75%, the proportion of clinics (physicians) that refer patients to clinics (physicians) that refer patients to evidence-based cessation treatment.evidence-based cessation treatment.

Increase to 100%, the proportion of Increase to 100%, the proportion of patients who are asked about tobacco patients who are asked about tobacco use status and documented at every use status and documented at every visit.visit.

Program IndicatorsProgram Indicators Increase to 90%, the proportion of Increase to 90%, the proportion of

patients who are advised to quit.patients who are advised to quit.

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

Program IndicatorsProgram Indicators

Increase to 50%, the proportion of patients Increase to 50%, the proportion of patients using tobacco who attempt to quit (i.e. using tobacco who attempt to quit (i.e. receive an appointment for cessation receive an appointment for cessation classes), for whom follow-up contact is classes), for whom follow-up contact is arranged.arranged.

Increase to 10%* annually the number of Increase to 10%* annually the number of smokers who are trying to quit, who stay smokers who are trying to quit, who stay abstinent for a full year or longer. abstinent for a full year or longer.

*National quit rate is 6 %

Breakout SessionBreakout SessionFacility RepresentationFacility Representation

Bogalusa Medical CenterBogalusa Medical Center Chabert Medical CenterChabert Medical Center Earl K. Long Medical CenterEarl K. Long Medical Center Huey P. Long Medical CenterHuey P. Long Medical Center Lallie Kemp Regional Medical CenterLallie Kemp Regional Medical Center Medical Center of LouisianaMedical Center of Louisiana University Medical CenterUniversity Medical Center W. O. Moss Medical CenterW. O. Moss Medical Center

Improvement StrategiesImprovement StrategiesBreakout Session FeedbackBreakout Session Feedback

Increase attendance ratesIncrease attendance rates Consider alternate scheduling processesConsider alternate scheduling processes Offer multiple timesOffer multiple times

Increase physician support/complianceIncrease physician support/compliance Engage nursing staff (nurse-friendly strategies)Engage nursing staff (nurse-friendly strategies) Continue/increase TCI Staff presenceContinue/increase TCI Staff presence PromptsPrompts

PostersPosters Chart indicators identifying tobacco usersChart indicators identifying tobacco users

Provide patient-related feedback (cessation Provide patient-related feedback (cessation updates)updates)

Improvement StrategiesImprovement StrategiesBreakout Session FeedbackBreakout Session Feedback

Increase the proportion of patients Increase the proportion of patients advised to quit by their provideradvised to quit by their provider Exit surveysExit surveys Peer reviewPeer review

MarketingMarketing Hospital NewslettersHospital Newsletters

Program AwarenessProgram Awareness Available classesAvailable classes Staff/Clinic recognitionStaff/Clinic recognition Special eventsSpecial events

Examine hospital policiesExamine hospital policies Market employee cessationMarket employee cessation

Future DirectionsFuture Directions2005 Objectives2005 Objectives

Complete hiring and training of field Complete hiring and training of field staffstaff

Establish standardized databaseEstablish standardized database

Create a formal indicator systemCreate a formal indicator system Standardize data sourcesStandardize data sources

Resource SchedulingResource Scheduling Abstraction SourcesAbstraction Sources Clinic forms revisionClinic forms revision

Establish HCSD website presenceEstablish HCSD website presence