Building a tobacco intervention system in managed care
 | Implementing tobacco interventions in the real world of managed care |
| Appendix |
Implementing tobacco interventions in the real world of managed care
Jack F Hollisa, Richard Billsa, Evelyn Whitlocka, Victor J Stevensa, John Mulloolya, Ed Lichtensteinb
a Center for Health
Research, Kaiser Permanente, 3800 N Interstate Avenue, Portland, OR
97227-1110, USA, b Oregon
Research Institute, Portland, Oregon, USA
Correspondence to: Dr Hollis hollisja@chr.mts.kpnw.org
| The first 150 words of the full text of this article appear below. |
 |
Introduction |
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Over the years we have been working to develop, test, and implement tobacco control interventions as a part of routine care within Kaiser Permanente. Most of our work has been in Kaiser Permanente's northwest division, based in Portland, Oregon, but we have also implemented similar approaches in several other divisions, including Ohio, Hawaii, and Georgia. I will first describe our general approach, which we call the TRAC model ("tobacco reduction, assessment, and care"), and then share both our progress and some very real difficulties we have encountered in trying to implement the program throughout the health care system.
The rationale for delivering brief tobacco intervention
during routine care is familiar to those who work in
cessation.1 Tobacco remains the most important cause of
preventable disease. We know that most smokers see clinicians
frequently, and that these visits create teachable moments
when patients are receptive to advice and intervention. When we
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