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These are the plans of Kaiser Permanente Northern California for implementing smoking as a vital sign; that is, assessing smoking status and offering patients information and advice at every primary care visit.
It is a “work in progress” because we have not yet begun to implement this programme throughout the region. This paper concerns what has worked in the past and the model we intend to implement in the future. We expect, however, that the process of implementation will alter this model, and our end product may be very different. I shall also suggest how to improve provider participation.
HEDIS tobacco measure
The current status of our Health Plan Employer Data and Information Set (HEDIS) tobacco measure (35–37%) reflects the relatively little staff time dedicated to tobacco issues at a regional level (although we have excellent smoking cessation materials and programmes available to all our members). Recently, the HEDIS tobacco measure has been chosen as one of the top five quality measures in the United States. That means that every Kaiser Permanente organisation in the country will be monitored and evaluated on their progress on this measure.
When, at our Regional Health Education facility in Richmond, Virginia, we began to consider implementing smoking as a vital sign, I started by looking for programmes already in place. What I found was a very simple and easy-to-implement programme, designed by one of our nurse practitioners. This method takes very little training, can be done in 15–20 seconds and is primarily the responsibility of the medical assistants. What follows is the summary.
The medical assistant greets the patient, and asks two questions: “Do you currently use tobacco?”. If the answer is yes, then: “Are you interested in quitting?”. If the answer is yes again, the patient is offered information on quitting smoking (a one-page, stage-based tear-sheet …