Strategy 2 - Capacity Building

    • May 25, 2010

What Is Known About Building Capacity to Provide Evidence-Based Cessation Treatment

The first prong of RWJF's plan to reduce tobacco use was to push the scientific evidence for tobacco-cessation treatments out to providers. But that strategy could only be effective if the health care system had the capacity to implement those treatments as RWJF learned in funding a small project at Allina Medical Clinic. See Program Results . The second aspect of RWJF's strategy was to increase the capacity of health care providers—including health care professionals and the facilities in which they work—to be able to integrate evidence-based tobacco-cessation treatments into routine care.

  • Systems-level strategies work. Researchers funded through Addressing Tobacco in Health Care found that clinical practices and health plans that implement specific health care strategies to facilitate delivery of tobacco-dependence treatment can effectively lower the incidence of smoking among their patients.

    The USPS Guidelines recommend the following evidence-based systems-level strategies to reduce smoking:
    • Implementing systems and registries to identify tobacco users.
    • Training clinicians to treat smokers.
    • Implementing systems to remind clinicians to ask about smoking status.
    • Giving clinicians incentives and reimbursement to include tobacco-dependence treatment in their core responsibilities.
    • Increasing smoker awareness of available Medicaid and health plan treatment benefits.
    • Dedicating staff to address smoking cessation.
    • Targeting hospitalized patients who smoke.
    • Providing insurance coverage for evidence-based tobacco-dependence treatments.
  • The most effective strategies are those that affect system operations. Reminder systems, for example, work, while provider education alone appears ineffective.

A review essay by Susan Curry shows progress has been made between 1996 (when RWJF entered this field) and 2006.

Key RWJF-Sponsored Initiatives: Research

  • Substance Abuse Policy Research Program (SAPRP) (1994–2010) and its predecessor, the Tobacco Policy Research and Evaluation Program (TPREP) (1992–96) have supported policy relevant, peer-reviewed research that increases understanding of policies for reducing the harm of tobacco use. These programs provided seminal findings showing the beneficial quitting effects from reducing smoker's out-of-pocket costs for tobacco-dependence treatments and creating smoke-free hospitals and hospital campuses. Results are summarized in SAPRP knowledge assets and reports, including "Increasing the Use of Smoking Cessation Treatments" and "A Research Agenda to Achieve a Smoke-Free Society." (See Program Results on SAPRP, Program Results on TPREP and SAPRP Knowledge Assets.)
  • Addressing Tobacco in Managed Care (ATMC) (1995–2005), supported evaluations of replicable efforts by managed care organizations to integrate effective tobacco-cessation interventions into everyday clinical practice and the basic health care they provide. ATMC studies evaluated the impact of reminder systems, coverage expansions, treatment promotions, provider and pay-for-performance incentives. (See Program Results, capstone meeting report and a conference report.)
  • Addressing Tobacco in Health Care (ATHC) (2005–08), which grew out of Addressing Tobacco in Managed Care, was a research network connecting researchers, health care providers and other partners interested in developing and implementing changes to health care systems to improve the delivery of tobacco-dependence treatments. The network facilitated collaboration among tobacco-control researchers, provided technical assistance for grant preparation and research dissemination and provided resources and tools to foster systems change research. (See conference report and other citations.)

Key RWJF-Sponsored Initiatives: Action to Put Research Into Practice

  • Including Cessation Treatment as a Measure of Quality. RWJF helped expand the national managed care "report card" on health care quality (known as the "HEDIS" measures) to include measures of the provider quit-smoking advice and assistance, including counseling and medications. These measures are included in major national public "pay-for-performance" measurement sets. (See Program Results on ID# 028757 and ID# 037080.)

Key RWJF-Sponsored Initiatives: Advocacy & Communications Around What Works

  • National Partnership to Help Pregnant Women Quit (December 2000 to December 2008) was a coalition of diverse organizations that joined forces to increase the number of pregnant smokers who quit smoking. The partnership's resources are available on its Web pages, hosted by the National Tobacco Cessation Collaborative (NTCC). They provide information for providers and patients, publications and tools on helping pregnant smokers quit.
  • Tobacco-Free Nurses (which RWJF supported from 2002 to 2008) builds capacity for tobacco cessation in two ways:
    • By helping nurses quit smoking, enabling them to serve as more effective quitting counselors for their patients
    • By providing training, tools and resources tailored to nurses' varied roles as cessation counselors in inpatient and outpatient settings. (See the Guide for Nurses, for example.)
    See Program Results for more information.
  • Smoking Cessation Leadership Center (2002–11) works with a variety of health professional organizations and institutions to increase their motivation and capability to refer smokers into treatment and their leadership to promote effective cessation treatments and policies. It has a special focus on smokers with co-occurring mental health and substance abuse problems. (See an article in the Journal of the American Medical Association by Steven Schroder, the director of the Smoking Cessation Leadership Center, in which he offers advice to clinicians who want to help smokers quit.)

Other Related Resources Funded by RWJF

Research

  • Results of a survey of access to tobacco-cessation treatment in managed care. (See journal article.)
  • A study of whether instituting smoking status as a "vital sign" within primary care practices would increase the likelihood that clinicians will advise patients to quit smoking. (See Program Results.)
  • A study of systems-level changes implemented by health care providers since the U.S. Public Health Service guideline was put in place in 1996. (See journal article.)

Action to Put Research Into Practice

  • The Smoking Cessation Leadership Center teamed up with the U.S. Veterans Administration to highlight best practices for cessation treatment in medical settings. (See conference report.)
  • A group of New Jersey managed care organizations worked together to improve tobacco prevention and cessation activities. (See Program Results.)
  • A working group convened to expand knowledge about reimbursement for smoking-cessation treatment and identify strategies to increase the availability and accessibility of treatment. (See Program Results.)
  • An initiative produced and distributed a multimedia educational tool to help health care practitioners treat tobacco dependence in pregnant women. (See Program Results.)
  • A review article that introduced pharmacological treatments for tobacco dependence to health care providers. (See journal article.)