Original Articles
The Role of Tobacco Intervention in Population-Based Health Care:: A Case Study

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Abstract

Managed care organizations are in an excellent position to implement population-based, as well as patient-centered, approaches to reduce behavioral risk factors associated with major chronic diseases. Group Health Cooperative of Puget Sound employed a population-based model for smoking that contributed to a decrease from 25% to 15.5% in smoking prevalence in 10 years among its more than 550,000 adult enrollees in western Washington. This model may have application to other arenas where health systems can support beneficial behavior change.

Section snippets

Background

How does a purchaser of health care make a decision favoring one health plan over another? Until recently, price has often been the primary, or even the only, determining factor. Price remains an important consideration, but purchasers are also beginning to look more closely at the total quality of the health plan, and prevention is an essential part of this.

The idea of measuring quality is not new, but until the advent of the National Committee on Quality Assurance (NCQA), a nongovernmental

Tobacco-Use Reduction

The identification of tobacco use as GHC’s number-one prevention area grew out of work done by a group of providers, planners, and researchers who formed a subcommittee sponsored by the COP. Their 1991 report, “Decreasing Tobacco Use at Group Health Cooperative,”[5]clearly delineated how tobacco met the COP’s review analysis format for disease prevention/health promotion issues. In summary, it documented the following:

  • 1.

    Tobacco use at GHC was prevalent. In 1985 over 25% of adult GHC members

Convergence Between Prevention and Quality of Care: Tobacco Road Map

GHC, like many MCOs, has been actively developing and implementing plans to improve health outcomes while, where feasible, reducing costs. To accomplish this challenging objective, GHC has developed a series of clinical road maps. These road maps, or plans developed by interdisciplinary teams from throughout the Cooperative, use the tools of total quality management and evidence-based medicine to focus on the critical areas that can have the greatest impact on the health of our members. These

Results

Measurement of process and outcome measures for GHC road maps, including tobacco, is coordinated by the Division of Clinical Planning and Improvement. Quarterly chart audits are conducted to measure the following process measures: documentation of tobacco-use status and provision of advice to quit for patients who smoke. In addition, tobacco-related questions have been included on phone-based satisfaction surveys as a way to annually measure tobacco-use prevalence and patient self-report of the

Replicability of the Model: Diabetes

The GHC effort to reduce tobacco use among its entire member population has demonstrated that it is possible for an MCO to take a population approach to a key health risk factor and get significant results. The next question is: can this conceptual approach be replicated for behaviors such as physical activity and diet or in a disease state like diabetes, cancer, or heart disease? Though the specific strategies applied to each risk factor or disease state could vary considerably, there is no

Conclusion

GHC’s experience with applying a population-based multisystem approach to tobacco-use reduction has shown great promise. We are actively engaged in applying this approach to other areas, such as diabetes. But condition-specific system design and implementation requires a lot of work. Developing numerous isolated programs is unlikely to be fundable or sustainable. Future delivery of quality preventive services, behavior change support, and patient education will require the development of an

References (12)

  • RS Thompson et al.

    A review of clinical prevention services at Group Health Cooperative of Puget Sound

    Am J Prev Med

    (1995)
  • U.S. Department of Health and Human Services. Healthy People 2000: national health promotion and disease prevention...
  • R Johnson et al.

    The roadmap for clinical quality

    HMO Pract

    (1994)
  • MJ McGinnis et al.

    Actual causes of death in the United States

    JAMA

    (1995)
  • McAfee TA, Curry S, Dacey S, Sofian N, Wilson J, Zeidman L. Decreasing tobacco use at Group Health Cooperative during...
  • JAMA

    (1996)
There are more references available in the full text version of this article.

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