Addressing Tobacco in Health Care

An RWJF National Program

Field of Work: Evaluating whether managed care organizations can integrate effective tobacco-cessation interventions into everyday clinical practice and the basic health care these organizations provide, and if these interventions can be replicated.

Problem Synopsis: Since the mid-1980s, researchers have developed a wealth of medications and behavioral interventions that can effectively treat nicotine addiction. In the mid-1990s, providers, public health professionals, health care leaders and policy-makers alike viewed the health care delivery setting as fertile ground for tobacco-cessation efforts because more than 70 percent of smokers visited a physician each year. The health care delivery system and health insurance plans were responding to the public health crisis of tobacco use with an after-the-fact stance. For example, every state Medicaid program covered expensive, intensive medical care to treat people with lung cancer, but in the mid-1990s only 24 state Medicaid programs covered treatment to help smokers quit. The Robert Wood Johnson Foundation saw an opportunity to embed evidence-based tobacco treatment in the routine delivery of health care to reach as many smokers as possible.

Synopsis of the Work: Addressing Tobacco in Managed Care (October 1996 to February 2009) evaluated the effectiveness of replicable organizational strategies that lead providers, practices and health plans to adhere to the activities recommended in evidence-based cessation guidelines. A collaboration among managed care organizations and academic researchers carried out 25 projects.

Key Research Program Assessment Findings: The Lewin Group conducted an assessment of the impact of the Addressing Tobacco in Managed Care research program in 2003:

  • Addressing Tobacco in Managed Care increased managed care organizations' awareness of the need for tobacco screening and cessation services.
  • The program was instrumental in developing a research base and a cadre of researchers examining tobacco-cessation interventions and the institutional changes needed to promote them.
  • Addressing Tobacco in Managed Care influenced changes within health systems and helped to "normalize" support for smoking cessation within health systems.
  • The program produced high-quality, useful research findings.
  • With its focus on "real-world" studies, Addressing Tobacco in Managed Care identified replicable, cost-effective, high-impact changes in health care systems relevant to tobacco cessation, as well as challenges and barriers to making those changes.
  • The findings from Addressing Tobacco in Managed Care have applicability for health behaviors and conditions beyond tobacco use.
  • The national research program office fostered partnerships and collaboration between tobacco researchers and managed care plans.

Research Findings

  • Among the findings reported by the researchers who received grants under the program were:

    • By capitalizing on the unique strengths of managed care organizations, feasible and replicable improvements in tobacco-dependence treatment delivery are achievable.
    • Systems innovations can increase the provision of evidence-based treatment to underserved and socioeconomically disadvantaged populations.
    • Reaching out to dental practices can foster tobacco user intervention.
    • Patient satisfaction is improved by providing tobacco-dependence treatments.
    • Electronic medical records are a promising means of documenting and facilitating the identification of smokers and the delivery of smoking-cessation interventions.
    • No single strategy or systems change will ensure that all tobacco users receive evidence-based care.