Targeting primary care referrals to smoking cessation clinics does not improve quit rates: Implementing evidence-based interventions into practice

Elizabeth M. Yano, Lisa V. Rubenstein, Melissa M. Farmer, Bruce A. Chernof, Brian S. Mittman, Andrew B. Lanto, Barbara F. Simon, Martin L. Lee, Scott Sherman

Research output: Contribution to journalArticle

Abstract

Objective. To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice. Data Sources/Study Setting. We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) primary care practices across five southwestern states. Study Design. In a group-randomized trial of 18 VA facilities, matched on size and academic affiliation, we evaluated intervention practices' abilities to implement evidence-based smoking cessation care following structured evidence review, local priority setting, quality improvement plan development, practice facilitation, expert feedback, and monitoring. Control practices received mailed guidelines and VA audit-feedback reports as usual care. Data Collection. To represent the population of primary care-based smokers, we randomly sampled and screened 36,445 patients to identify and enroll eligible smokers at baseline (n=1,941) and follow-up at 12 months (n=1,080). We used computer-assisted telephone interviewing to collect smoking behavior, nicotine dependence, readiness to change, health status, and patient sociodemographics. We used practice surveys to measure structure and process changes, and administrative data to assess population utilization patterns. Principal Findings. Intervention practices adopted multifaceted EBQI plans, but had difficulty implementing them, ultimately focusing on smoking cessation clinic referral strategies. While attendance rates increased (p<.0001), we found no intervention effect on smoking cessation. Conclusions. EBQI stimulated practices to increase smoking cessation clinic referrals and try other less evidence-based interventions that did not translate into improved quit rates at a population level.

Original languageEnglish (US)
Pages (from-to)1637-1661
Number of pages25
JournalHealth Services Research
Volume43
Issue number5 P1
DOIs
StatePublished - Oct 1 2008

Fingerprint

Smoking Cessation
Primary Health Care
Quality Improvement
Veterans Health
Referral and Consultation
United States Department of Veterans Affairs
Guidelines
Population
Tobacco Use Disorder
Aptitude
Process Assessment (Health Care)
Information Storage and Retrieval
Health Facilities
Telephone
Health Status
Smoking
Surveys and Questionnaires

Keywords

  • Quality of health care
  • Smoking cessation
  • Veterans

ASJC Scopus subject areas

  • Health Policy

Cite this

Targeting primary care referrals to smoking cessation clinics does not improve quit rates : Implementing evidence-based interventions into practice. / Yano, Elizabeth M.; Rubenstein, Lisa V.; Farmer, Melissa M.; Chernof, Bruce A.; Mittman, Brian S.; Lanto, Andrew B.; Simon, Barbara F.; Lee, Martin L.; Sherman, Scott.

In: Health Services Research, Vol. 43, No. 5 P1, 01.10.2008, p. 1637-1661.

Research output: Contribution to journalArticle

Yano, Elizabeth M. ; Rubenstein, Lisa V. ; Farmer, Melissa M. ; Chernof, Bruce A. ; Mittman, Brian S. ; Lanto, Andrew B. ; Simon, Barbara F. ; Lee, Martin L. ; Sherman, Scott. / Targeting primary care referrals to smoking cessation clinics does not improve quit rates : Implementing evidence-based interventions into practice. In: Health Services Research. 2008 ; Vol. 43, No. 5 P1. pp. 1637-1661.
@article{b5bc4a9b690e4b80b94318e29325f61d,
title = "Targeting primary care referrals to smoking cessation clinics does not improve quit rates: Implementing evidence-based interventions into practice",
abstract = "Objective. To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice. Data Sources/Study Setting. We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) primary care practices across five southwestern states. Study Design. In a group-randomized trial of 18 VA facilities, matched on size and academic affiliation, we evaluated intervention practices' abilities to implement evidence-based smoking cessation care following structured evidence review, local priority setting, quality improvement plan development, practice facilitation, expert feedback, and monitoring. Control practices received mailed guidelines and VA audit-feedback reports as usual care. Data Collection. To represent the population of primary care-based smokers, we randomly sampled and screened 36,445 patients to identify and enroll eligible smokers at baseline (n=1,941) and follow-up at 12 months (n=1,080). We used computer-assisted telephone interviewing to collect smoking behavior, nicotine dependence, readiness to change, health status, and patient sociodemographics. We used practice surveys to measure structure and process changes, and administrative data to assess population utilization patterns. Principal Findings. Intervention practices adopted multifaceted EBQI plans, but had difficulty implementing them, ultimately focusing on smoking cessation clinic referral strategies. While attendance rates increased (p<.0001), we found no intervention effect on smoking cessation. Conclusions. EBQI stimulated practices to increase smoking cessation clinic referrals and try other less evidence-based interventions that did not translate into improved quit rates at a population level.",
keywords = "Quality of health care, Smoking cessation, Veterans",
author = "Yano, {Elizabeth M.} and Rubenstein, {Lisa V.} and Farmer, {Melissa M.} and Chernof, {Bruce A.} and Mittman, {Brian S.} and Lanto, {Andrew B.} and Simon, {Barbara F.} and Lee, {Martin L.} and Scott Sherman",
year = "2008",
month = "10",
day = "1",
doi = "10.1111/j.1475-6773.2008.00865.x",
language = "English (US)",
volume = "43",
pages = "1637--1661",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "5 P1",

}

TY - JOUR

T1 - Targeting primary care referrals to smoking cessation clinics does not improve quit rates

T2 - Implementing evidence-based interventions into practice

AU - Yano, Elizabeth M.

AU - Rubenstein, Lisa V.

AU - Farmer, Melissa M.

AU - Chernof, Bruce A.

AU - Mittman, Brian S.

AU - Lanto, Andrew B.

AU - Simon, Barbara F.

AU - Lee, Martin L.

AU - Sherman, Scott

PY - 2008/10/1

Y1 - 2008/10/1

N2 - Objective. To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice. Data Sources/Study Setting. We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) primary care practices across five southwestern states. Study Design. In a group-randomized trial of 18 VA facilities, matched on size and academic affiliation, we evaluated intervention practices' abilities to implement evidence-based smoking cessation care following structured evidence review, local priority setting, quality improvement plan development, practice facilitation, expert feedback, and monitoring. Control practices received mailed guidelines and VA audit-feedback reports as usual care. Data Collection. To represent the population of primary care-based smokers, we randomly sampled and screened 36,445 patients to identify and enroll eligible smokers at baseline (n=1,941) and follow-up at 12 months (n=1,080). We used computer-assisted telephone interviewing to collect smoking behavior, nicotine dependence, readiness to change, health status, and patient sociodemographics. We used practice surveys to measure structure and process changes, and administrative data to assess population utilization patterns. Principal Findings. Intervention practices adopted multifaceted EBQI plans, but had difficulty implementing them, ultimately focusing on smoking cessation clinic referral strategies. While attendance rates increased (p<.0001), we found no intervention effect on smoking cessation. Conclusions. EBQI stimulated practices to increase smoking cessation clinic referrals and try other less evidence-based interventions that did not translate into improved quit rates at a population level.

AB - Objective. To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice. Data Sources/Study Setting. We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) primary care practices across five southwestern states. Study Design. In a group-randomized trial of 18 VA facilities, matched on size and academic affiliation, we evaluated intervention practices' abilities to implement evidence-based smoking cessation care following structured evidence review, local priority setting, quality improvement plan development, practice facilitation, expert feedback, and monitoring. Control practices received mailed guidelines and VA audit-feedback reports as usual care. Data Collection. To represent the population of primary care-based smokers, we randomly sampled and screened 36,445 patients to identify and enroll eligible smokers at baseline (n=1,941) and follow-up at 12 months (n=1,080). We used computer-assisted telephone interviewing to collect smoking behavior, nicotine dependence, readiness to change, health status, and patient sociodemographics. We used practice surveys to measure structure and process changes, and administrative data to assess population utilization patterns. Principal Findings. Intervention practices adopted multifaceted EBQI plans, but had difficulty implementing them, ultimately focusing on smoking cessation clinic referral strategies. While attendance rates increased (p<.0001), we found no intervention effect on smoking cessation. Conclusions. EBQI stimulated practices to increase smoking cessation clinic referrals and try other less evidence-based interventions that did not translate into improved quit rates at a population level.

KW - Quality of health care

KW - Smoking cessation

KW - Veterans

UR - http://www.scopus.com/inward/record.url?scp=47749083879&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=47749083879&partnerID=8YFLogxK

U2 - 10.1111/j.1475-6773.2008.00865.x

DO - 10.1111/j.1475-6773.2008.00865.x

M3 - Article

VL - 43

SP - 1637

EP - 1661

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 5 P1

ER -