Group Health Cooperative of Puget Sound (GHCPS) is a consumer-governed health organisation with over 500 000 members. It has a 20-year track record of consciously attempting to improve the quality of preventive care for its members. We think of ourselves as a managed care organisation attempting to metamorphose into a health improvement organisation.1 This means we are not only in the business of managing health care, but we are also committed to improving the health of our members and the community. I will describe the efforts of GHCPS to develop and maintain an effective and comprehensive evidence-based approach to decreasing the prevalence of tobacco use among our members. This effort has become one of our showcase examples of what it means to be a health improvement organisation. I will pay particular attention to the role of measurement in success, including our own measurement systems, and the new tobacco Health Plan Employer Data and Information Set (HEDIS) measure.

In 1991, a group of physicians, nurses, planners, and researchers began meeting regularly to discuss what GHCPS could do, in an organised way, about tobacco use. This work was sponsored by our Committee on Prevention, and led to the formation of a detailed plan that embodied most of the elements of the National Cancer Institute’s “4A” model for clinical smoking control. The plan also closely resembled the recently published Agency for Health Care Policy and Research smoking cessation guideline.2 It called for systematic identification, advice, assistance, and follow up for all tobacco users at all encounters with our system. It also called for the provision of coverage for smoking cessation services, as well as legislative and other community efforts. In the next two years, this agenda was adopted by our developing quality improvement infrastructure. Decreasing the prevalence of tobacco use became GHCPS’s …