Institute 2010: Tobacco Policy & Health Systems Change

While some of this workshop was deep talk from state viewpoint about changing systems, they did do a great review of best strategies for how to get a health care agency to integrate routine cessation interventions. Considering I bet every community has a few LGBT friendly docs with large natural LGBT patient populations, focusing on getting these community-friendly offices to change can probably have a big impact on LGBT smoking status community-wide.

Background: Multi-state Collaborative for Health Systems Change

Who is this? It’s a group of 20 states that have partnered with national groups to pioneer better integration of cessation services into routine health care. See lots of great case studies and tools about this on their website.

How do we integrate better cessation into health care systems? Most current leading edge work is still focused on the basics: getting medical providers to do the AAR, or Ask, Advise, Refer model from the Public Health Guidelines. Referrals these days are often through fax forms to quitline, which allow nice followup contact between quitline & doc.

Entree: Best tips and tricks for getting health care providers to integrate cessation?

Note: This is a real time of change for providers, healthcare reform is going to usher in conversion to electronic health records for all soon, so it’s a great time to address tobacco use well. See some bullets on this at end.

• Assess current tobacco intervention process (multi state collab has assessment tools on their website)
• ID clinical and administrative champion (make sure clinical champion is high enough up ladder)
• See if they have electronic health records for at least 2 yrs (so they’ve worked out bugs) (you can change systems without this but much harder to track change)
• The newer AAR (Ask, Assist, Refer) intervention is good & takes less time than the old intervention (aka “5As” from the old guidelines).
• Try to advocate for smoking assessment to be part of vital signs (taken at each visit) versus other medical info (not looked at too often). And it should be required vital sign, not optional.
• Might not be doc taking vital signs, could be nurses, make sure you have champion there!
• American Acad of Family Physicians and Amer Acad of Pediatrics have full Ask and Act toolkit for providers to integrate this work into their routine. Lots of templates and resources there, esp for elec health record integration.
• Have info technology (IT) person at table from start, esp to plan to routinely circulate performance info reports (# smokers identified, # brief interventions, # referrals, by provider). Docs are competitive & like to do well!
• Train staff, test changes (revise if needed), implement the feedback reports (see sample reports on web)
• There is new money under healthcare reform to assist many medical practices to convert to electronic health records, I hear $44k per doc.
• Eventually, healthcare reform changes means docs will get lower medicare and medicaid payments if they don’t have electronic health records that collect key info, like tobacco use.
• See Federal Health IT website for details on how new electronic records need to meet “meaningful use” guidelines and for local tech support for conversions.

Bonus Tidbit: Best Tobacco Healthcare Reform Briefing Sheet

University of Wisconsin has boiled down the several thousand page Affordable Healthcare Act to 7 pages of what changes for tobacco and when those changes roll out. These folk say it’s the best summary they’ve seen, download it here.