Healthcare programmes, services, and practitioners in the USA and many other western countries are being held increasingly accountable for quality, safety, and cost effectiveness. Performance measurementa first step toward assuring qualityis being integrated into all aspects of healthcare. Government agencies, large employers, and other institutions that pay for medical care are insisting on accountability, in response to the growing demand for medical services; the introduction of new, expensive technologies and pharmaceuticals; studies showing that medical practice often does not conform to evidence based guidelines; geographic variations in the utilisation of medical services; and the high incidence of serious medical errors.^1-3

Curiously, the treatment of tobacco dependence has not been part of this picture. Evidence based guidelines for smoking cessation treatment exist,^4-7 and recommended interventions are extremely cost effective.⁸ But there is little effort to ensure compliance with guidelines among programmes and providers being paid to help smokers quit.