Original ArticlesThe Role of Tobacco Intervention in Population-Based Health Care:: A Case Study
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:
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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
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Smoking cessation treatment on the internet
2007, Archivos de BronconeumologiaOrganization, Financing, Promotion, and Cost of U.S. Quitlines, 2004
2007, American Journal of Preventive MedicineCitation Excerpt :Quitline services tend to be available many hours during the day and on weekends, further enhancing their potential reach. Because of these features, smokers are four times more likely to use a quitline than to seek face-to-face counseling.2 Quitlines also have the potential to reach the elderly, those living in rural areas, those of lower socioeconomic status, and racial/ethnic minorities—populations that may not have ready access to in-person cessation services.
Inferring Strategies for Disseminating Physical Activity Policies, Programs, and Practices from the Successes of Tobacco Control
2006, American Journal of Preventive MedicineCitation Excerpt :Helpful systems-level changes included a registry of tobacco users, measurement and performance reports, incentives for provider adherence to practice guidelines, computer-generated provider prompts, and patient post-visit telephone counseling calls, cessation specialist office staff, referral to community resources for additional patient support, and clinician/health plan advocacy for community policies that motivate and support quitting. Using a combination of such strategies to re-engineer office and health plan practice systems, several health plans and federally qualified health centers serving a low-income minority population have achieved dramatic success.52–55 Having evidence-based guidelines both for clinical interventions and for systems change and policy interventions has enabled healthcare and tobacco-control leaders to advocate for and achieve the major advances outlined below:
The Top Priority. Building a Better System for Tobacco-Cessation Counseling
2006, American Journal of Preventive Medicine