Integrating Tobacco Control into Health Care Delivery Charles J. Bentz, MD, FACP Medical Director:...

Integrating Tobacco Control into Health Care Delivery

Charles J. Bentz, MD, FACP

Medical Director: Tobacco Cessation and Prevention

Providence Health System: Oregon

Quitting saves lives… •34,439 male British doctors•Smokers die 10 years younger•Cessation improves life expectancy

Doll R. et al. Mortality in relation to smoking: 50 years‘ observations on male British doctors BMJ, doi:10.1136/bmj.38142.554479.AE (June 2004)

Age quit Years gained

30 10

40 9

50 6

60 2

What is Success?• Spontaneous Quit Rates 2-3% quit @ 1 year • Office-based (dose-response)

– Minimal Counseling: 4%– Brief Counseling: 5%– Counseling: 8-10%

• Interactive internet 5-10%• Interactive telephone 10-25%• Group classes 15-25%• Classes with medication 25-35%• Residential treatment 45-50%

Public Health Service Guideline 2000Hughes et al, CA cancer journal clinic, 2000 50:143Providence Tobacco Cessation & Prevention Program

Costs of Smoking

• Business Costs of employees who smoke:– Greater absenteeism– Time spent on smoking rituals– Higher health care costs– Higher life insurance premiums– Higher risk of industrial/occupational injury– Higher disability costs– Higher number of disciplinary actions

Indirect Employer Costs:

• On average– Male smokers miss 3.9 more days/yr– Female smokers miss 2.1 more days/yr

• In Oregon– Annually 1,000,000 lost days: $100,000,000– Annual costs of lost productivity due to

premature deaths: $600,000,000

Warner KE, Journal of Occupational & Environmental Medicine, 1996Oregon Tobacco Facts: Department of Human Services, October 2001

Direct Medical Costs in Oregon

• Smokers use the health care system 50% more than non-smokers

• Annual direct medical expenditures:– Private individuals / business: $450,000,000– Public funds: $350,000,000

• Annual cost per tobacco user: $3000

• Annual cost per Oregonian: $750Oregon Tobacco Facts: Department of Human Services, October 2001Clearing the Air at Work: Orange County Health Care Agency, 1994

Cost of workplace tobacco dependence

$ 1,000,000

$ 2,000,000

$ 3,000,000

$ 4,000,000

$ 5,000,000

$ 6,000,000

$ 7,000,000

1,000 2,000 3,000 4,000 5,000 6,000

Blue colla

r (36%)

White collar (15%)Mixed workforce (26%)

Source: Mercer Human Resources Consulting, New York, NY

Number of employees

Cost-Effectiveness

Quist-Paulsen P, et al. Eur J Cardiovasc Prev Rehabil, 2006, 13(2):274-280

Treating tobacco dependencereduces costs

• Comprehensive tobacco dependence treatment achieves quit rates of 10%to 35% per year

• No other disease prevention measures are as well tested or successful

• Employers can realize positive first-year returns on this investment and future returns exceeding 300%

US Department of Health and Human Resources, Rockville, MD Mercer Human Resources Consulting, New York, NY

How do we do a better job….

…treating tobacco use and dependence?

Treating Tobacco Dependence: 1993

SMOKER(who wants to quit)

Cessation•Group Classes•Pay Full Price•2 dozen / yr

Providence Health System Task Force on Tobacco Cessation and Prevention

• Physician Leader• Program Manager• Respiratory Care• Pharmacy• Human Resources• Behavioral Health• Employer Health• Prov-RN

• Health Education• Research Analyst• Oregon Lung

Association • Quality Management• Women & Children’s

Program• Thoracic Oncology• E-Health Representative

Prevention Planning Process: 1994

ProvidersWe need to have a dedicated Physician Champion who can lead this effort. We also need provider education and incentive

InterventionsWe need to put in place the benefits for evidence-based interventions to help current smokers quit

ClinicsWe need to develop and implement changes in infrastructure needed to address tobacco systematically in clinics

Health SystemWe need to have a regional focus on every thing we do. The health system needs to win.

Target GroupsIn addition to population based efforts, we also need to target those at highest risk, employees, and special populations

CommunityFrom the start we need to strategically partner to allow for a prevention focus (vs. treatment)


EvaluationWe need to make measuring qualitative and quantitative outcomes a priority

HospitalsAcute care is the key strength of our health system

Treating Tobacco Dependence : 1994

Providers•Physician Leadership


Cessation•Group Classes•Pay Full Price


Providers•Physician Leadership

Cessation•Group Classes

•$5 copay•Self-Help Materials

Clinics•EMR Resources

Health System•Prevention Planning

Target Groups•PHS employees

Community•TOFCO



Providers•Physician Leadership•5 A’s Training/Education

Cessation•Group Classes•Self-Help Materials•NRT Benefit•Telephone Support

Clinics•EMR Resources•5 A’s Training

Health System•Population Health Improvement

Community•TOFCO•Legislation

Hospital-Based•Inpatient Program

•Proposal

Evaluation•C.O.R.E.•Utilization


Target Groups•PHS employees


Providers•Physician Leadership•5 A’s Training/Education•Reimbursement

Cessation•Group Classes•Self-Help Materials•NRT benefit•Telephone Support

Clinics•5 A’s Training•EMR Resources

Health System•PHI funding•Statewide Guideline

Target Groups•PHS employees •Clinical Programs

Community•TOFCO•Legislation•Guideline

Hospital-Based•Inpatient Program

•2nd proposal

Evaluation•C.O.R.E.•Utilization•CQI



Providers•5 A’s Training/Education•Reimbursement •Physician Leadership

Cessation•Group Classes•Medication benefit•Telephone Support•Self-Help Materials

Clinics•5 A’s Training•EMR Resources•Resources: Primary Care, Specialties, Pediatrics, OB/GYN

Health System•Funded Research

•$180,000

Target Groups•Disease Management•PHS employees• OMAP Project Prevention

Community•TOFCO•Legislation•Oregon Quit Line

Hospital-Based•Inpatient Program•Behavioral Health/CD

Evaluation•C.O.R.E.•Programs•CQI





Clinics•5 A’s Training•EMR Resources•Paper-Based Resources•Resources: Primary Care, Specialties, Pediatrics, OB/GYN


•$230,000

Target Groups•Disease Management•PHS employees•Primary Care



Evaluation•C.O.R.E.•Programs•Research







•$260,000•NCQA Accreditation•1st AAHP Award

Target Groups•Disease Management•PHS employees• Women & Children



Evaluation•C.O.R.E.•Research•Publications





Clinics•5 A’s Training•EMR Resources•Provider feedback•Resources: Primary Care, Specialties, Pediatrics, OB/GYN


•$810,000•2nd AAHP Award

Target Groups•Disease Management•PHS employees• Women & Children







Cessation•Group Classes•Free Medications•Telephone Support•Self-Help Materials•Prov-RN


Health System•Research > $800K•OR DHS Award•3rd AAHP Award

Target Groups•Disease Management•PHS employees•Women & Children•Web-Based









Health System•Research > $800K•Leadership: ATMCRWJF, CDC, AAHP•H.S.I. Program

Target Groups•Disease Management•PHS employees•Web-Based•Women & Children•Clinical Programs

Community•TOFCO•Oregon Quit Line•Business Case


Evaluation•C.O.R.E.•Utilization•CQI





Clinics•5 A’s Training•EMR Resources•Resources: Primary Care, Specialties, Pediatrics, OB/GYN•TAR SOFTWARE outreach

Health System•Research > $800K•H.S.I. Program•Leadership: ATMCAAHP-HIAA

Target Groups•Disease Management•PHS employees/policy•Web-Based•Women & Children•Clinical Programs

Community•Oregon Quit Line•Make it Your Business•Statewide Conference


Evaluation•C.O.R.E.•Clinical programs





Clinics•5 A’s Training•EMR Resources•Resources: Primary Care, Specialties, Pediatrics, OB/GYN•TAR SOFTWARE outreach

Health System•Research > $800K•H.S.I. Program•Leadership: CMS•4th National Award

Target Groups•Disease Management•PHS campus policy•Web-Based•Women & Children•Clinical Programs

Community•Oregon Quit Line•MIYB grant•TOFCO/Chest Watch


Evaluation•C.O.R.E.•Clinical programs•Publications



Providers•Provider Education•Reimbursement •Physician Leadership

Cessation•Group Classes•Free Medications•Telephone Support•Self-Help Materials•Nurse Help Line

Clinics•5 A’s Training•Electronic Health Record•Connection to Quit Line

Health System•National Awards•National Benchmark•NCQA Accreditation

Target Groups•PHP Disease Mgmnt•PHS employees•Web-Based•Women & Children•Clinical Programs (TOP)

Community•Tobacco Tax•Oregon Quit Line•TOFCO (MIYB)


Evaluation•Tobacco a QI•Research



Providers•Education•Reimbursement •Physician Leadership

Cessation•Group Classes•Free Medications•Telephone Support•Self-Help Materials•Nurse Help Line

Clinics•5 A’s Training•Electronic Health Record•Quit Line Connection

Health System•National Benchmark•CDC, RWJF, SCLC•NCQA, ATHC, LA

Target Groups•Disease Management•PHS employees•Web-Based•Women & Children•Clinical Programs

Community•Oregon Quit Line•TOFCO (MIYB)•Step Up!


Evaluation•Research•Tobacco as QI•GWTG, CMS


Smoking Prevalence in PHP vs. Oregon

15%16%17%18%19%20%21%22%23%24%

State of Oregon (BRFS) Providence Health Plan: Oregon

“The program at Providence is the platinum standard

for tobacco cessation in health systems”

Steve Schroeder MDDistinguished Professor of Health and Health Care

Director: Smoking Cessation Leadership CenterUniversity of California San Francisco

September 24, 2004

It takes a clearly identified goal…

“At every point where patients come into contact with our health

system, tobacco use will be assessed and addressed.”

Providence Tobacco Task Force, 1994

How can we do a better job of addressing tobacco?

Clinic: It starts by making tobacco-use a vital sign…

Then you progress to the Five A’s of Tobacco Cessation

• ASK: about tobacco use at every visit

• ADVISE: urge all tobacco users to quit

• ASSESS: willingness to quit

• ASSIST: aid the patient in quitting

• ARRANGE: schedule follow-up

The “Motel Syndrome”

“Many group-practices are really solo-practices in disguise”

5 A’s in Providence

• ASK: Nurse (vital sign)

• ADVISE: Provider (brief, clear)

• ASSESS: Provider (ready to quit?)

– NO: Message and move on

• ASSIST: – Refer to the Oregon Quit-Line

– Counseling and Medication

– Referral to Behavioral Program

• Cessation classes

• Providence Resource Line

• www.providence.org/classes

• ARRANGE: – Quit Line refers to programs

– Make a follow-up appointment

ASKASKADVISEADVISE

Two Options for Two Options for Connection with Connection with

QuitlineQuitline

Diagram of “Quit Line Connection” in Primary Care

ARRANGEARRANGE

ClinicClinic

ClinicClinic

Patient completes Form. Form faxed to Quit Line. Quit Line contacts patient.

After initial smoking cessationintervention, QuitLine staff refer patients to appropriate resources

and return fax form to clinic

PatientPatient

Oregon Quit LineOregon Quit Line

Brochure givenPatient contacts quitline

at their convenience.

PatientPatient

Tobacco Use Documented in

Chart Advice to quit and Stage of readiness to quit Documented in ChartProvider refers to Quit Line

ASSESSASSESS

ASSISTASSIST

Free & ClearFree & Clearoror

Local ProgramsLocal Programs

ProgramProgram

Bentz CJ, et al. American Journal of Preventive Medicine,2006. 30(1): 31-37.

Paper Quit LineFax Form

Electronic Quit Line Fax Form

“Quit Line Connection”

• This is a best practice for cessation• Offloads providers and streamlines process• Inexpensive, feasible, well accepted• “Front-Door” to Providence tobacco

program• Oregon DHS has resources available

– DHS can send someone to your office– 5 A’s training– Set up a “Quit Line Connection”

Am J Prev Med 2006;30(1)

Type of Connection

Cost per

connect

Comment

Physician Office

Year 1$15-38 This varies depending upon whether

you include the cost of reimbursement for provider time and food (pizza).

Physician Office

Subsequent years$4 This is based upon the assumption

that referral rates remain relatively stable in subsequent years.

Media-Driven campaign $100-400 This does not include production costs, royalty fees, contract management, media coordination.

Louisiana Tobacco Quit Line In operation since September 2000

Website: www.mytfl.org

Number: 1 (800) QUIT NOW Languages: English, Mandarin, Cantonese, Korean, Vietnamese, French, Russian, over 150 languages Hours of Operation:Counseling available: Mon 6:00 to 23:00Tues 6:00 to 23:00Wed 6:00 to 23:00Thurs 6:00 to 23:00Fri 6:00 to 20:00Sat 8:00 to 18:00Sun 8:00 to 18:00

Live pickup of incoming calls: Mon 24 hoursTues 24 hoursWed 24 hoursThurs 24 hoursFri 24 hoursSat 24 hoursSun 24 hours

Louisiana Tobacco Quitline

• Counseling: – Unlimited sessions– 1st session: 30 min– Follow-up: 10-15 min

• Web Services– Cessation Information – Web-based cessation

intervention– chat room

• Other Services– Voice mail with call back, referral

to other services– Fax referral for providers and

others– Mail or email self-help information

Who should call the Quit Line?

• Teen tobacco users

• Pregnant tobacco users

• Smokeless tobacco users

• Former smokers who need relapse prevention

• Providers who require information for patients

• Friends and relatives of tobacco users

• Non-English speaking tobacco users

You can lead a horse to water…

but you can't make him drink.

John Heywood (c.1497-1580)

Changing Provider Behavior

• Passive strategies are ineffective (CME)• Active approaches are more effective

– Educational Outreach– Audit and Feedback– Prompts and Reminders– Multi-faceted approaches are most effective

• Not much is known about the specifics• Incentives are effective ($$)

5 A’s Tobacco Cessation Using A Primary Care EMR

Portland, Oregon

Principal Investigator: Charles J. Bentz MD, FACP

Co-Investigators & Research Team: K. Bruce Bayley, PhDErik BergstromKerry Bonin, MPHNancy Davis, MPHLori FlemingJack Hollis, PhDJacquelyn Hunt, PharmDBenjamin H. LeBlanc, MDTimothy McAfee, MD, MPH Joseph Siemienczuk, MD

Feedback Study: Design

20 EMR Clinics:Quitline Connection

Training in 5 A’sMatched based on

Clinic Size, Payor mix,Baseline Ask rates

Intervention: Monthly Feedback on 5 A’s that are

documented in EMR

Control:No Feedback

R

Primary Outcome:

Number of patients connecting with the Tobacco Quit Line

Secondary Outcomes:

EMR rates of 5 A’s, Qualitative analysis, Cost Effectiveness analysis

Results: EMR Documentation

*Adjusted for cluster effects, presence of clinic champion, case mix, baseline ask rates, insurance mix, clinic size, volume

Bentz CJ, et al. Nic & Tob Res. March 2007 9(3)

Results: Quit Line Contact

Bentz CJ, et al. Nic & Tob Res. March 2007 9(3)

Conclusions: • EHR-generated feedback increases documentation

of assistance with tobacco cessation. • Two important predictors:

– patient case mix – presence of a local clinic champion

• Feedback is more effective when combined with alerts and reminders

• The feedback instrument should focus on a single key measure

Quit Line Disruption • Due to budget crisis, funding ceased April 2003 • This disruption had a major impact on referral• This highlights the need for stable funding • Any health system considering the use of a state-

level quit line as the prime referral source:– Should meet with the state agencies and the service

provider to ensure stability of funding and service

– If funding is not secure, other mechanisms such as direct contracting for service should be considered

What about the hospitals?

Step Up!

• Cessation benefits for all hospital employees

• The Five-A’s for all hospitalized patients

• Pharmacist-assisted cessation classes

• Hospital tobacco-free campus policies

• Help hospitals provide leadership for local businesses to curb tobacco use

State of Oregon TPEP, OAHHS, Acumentra Health, ONA, SCLC, hospitals, and health systems and professional associations in Oregon

Providence Health System Pharmacist-Assisted Cessation Classes

• Three Portland Hospitals• 11-sessions over 8 weeks• Medication included

– Patch, bupropion, or varenicline– No out-of-pocket expense– Pharmacist leads first class, attends the

second class, remains available – Partial fill (every 2-3 weeks)

• PHP $15, General Public $225• 33-35% 1 year quit rates

Patients can register online at www.providence.org/classesor call the Providence Resource Line at 503-574-6595

Inpatient Smoking Cessation

In terventionM o tiva tio n a l

C o g n it ive / B eh a vio ra l

R eso urces"S u rv iva l K it"

R e fe rra l In fo rm a tion

P h arm aco th erapyP re -p rin te d O rd er S e t

N R T / N on -n ico tine

N o tifica tio n o f P CPP e rso n a l L e tte r

R e so u rces

INTERVENTIONAssessment by T rained Therapis t

"D o you need he lp w h ile in Hosp ita l?""A re you in te rested in rem a in ing S m oke-F ree?"

RESPIRATORY CAREDaily Census of Inpatient Smokers

P rin ted e very m orn in g in R esp ira to ry C a re D e p a rtm e nt

ACCESS SERVICESSystematic Identification of Current Smokers

E very pa tien t asked "H ave you sm oked in the past yea r?"Ask

Advise

Assess

Assist

Arrange

It starts at admitting…

Tobacco Use Status Ascertainment at Admission: Portland Service Area Hospitals

0%

20%

40%

60%

80%

100%

Aug-9

8

Oct-9

8

Dec-9

8

Feb-9

9

Apr-9

9

Jun-9

9

Aug-9

9

Nov-9

9

Jan-0

0

Mar

-00

May

-00

Jul-0

0

Sep-0

0

Nov-0

0

Jan, 0

1

Mar

,01

May

, 01

Jul, 0

1

Sept,

01

Nov, 0

1

Jan, 0

2

Mar

, 02

May

, 02

July,

02

Sept,

02

PMH PPMC PSVMC

ProvidenceTobacco Dependent Patient Dosing Guideline

Systematic vs. Non-Systematic: PHS Inpatient Cessation Program

Data: HBOC

0

2000

4000

6000

8000

10000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Inpatient smokers counseled in 3 PSA hospitals

You can’t change what you can’t measure…

W. Edwards Deming (1900-1993)

Key Points on Measurement

1. Use sampling – frequent, small samples

2. Define quantitative vs. qualitative measures

3. Use outcome, intermediate and process measures

4. Don’t let unsophisticated systems slow you down

5. Plot data over time, with short time intervals

6. Seek usefulness not perfection

7. Integrate measurement into the daily work

Nelson EC, Annals Int Med. 1998, 128:460-466

Being a “Change Agent”

‘Change’ is not so much about overcoming resistance as it is about creating attraction…

‘Resistance’ is really attraction to factors in the current system that we might not fully appreciate

Paul Plsek

Being a “Change Agent”• Learn to recognize naturally occurring change• Identify “Attractors”• Explore rationality of other’s point of view• Reduce Risk for those involved• Understand the issues of those you wish to change• Create changes that are “Exothermic”• Produce system changes• Accept responsibility and learn from failures• Focus on building relationships of trust

Health System Conclusions…

• Starts with enlightened administrators– If no ‘top-down’ try ‘sideways-in’– The ‘Deep Throat’ analogy: “Follow the Money…”

• Multi-Disciplinary Group/Physician Champion• Start with comprehensive cessation benefits• Do one thing at a time and do it well• The Oregon analogy: If you plant enough trees,

pretty soon you will have a forest….• Community focus

Lessons we learned…

• Local Ownership of Process

• Coordination and Sharing of Resources

• Focus on the customer

• Understanding Change Agency

• Patience and Optimism

• Tobacco Cessation is a team sport

Step Up!

• Every Hospital in Oregon– Robust Cessation Benefits– 5 A’s for All Hospitalized Patients– Pharmacist-Assisted Cessation Classes– Tobacco-Free Hospital Campus– Community Leadership in Cessation

State of Oregon TPEP, OAHHS, Acumentra Health, ONA, SCLC, hospitals, and Providence Health System and many other health systems and professional associations in Oregon

NorthamptonWarren

Lee

Wilkes

Henderson

Watauga

Scotland

Guilford

Rockingham

Moore

AnsonRichmond

Cabarrus

Stanly

Surry

Forsyth

Stokes

Davidson

RandolphRowan

Lincoln

Gaston

Iredell

CaldwellAlexander

Catawba

Burke

McDowell

Buncombe

Polk

MadisonYancey

Cherokee

Graham

ClayMacon

Jackson

Swain

Avery

Davie

Montgomery

Mitchell

Haywood

Wake

Granville

Person

Orange

Hoke

Robeson

Columbus

Brunswick

PenderBladen

Sampson

Duplin

Onslow

Jones

Lenoir

Johnston

Harnett

Carteret

CravenPamlico

BeaufortHyde

Tyrrell Dare

Gates

Hertford

Bertie

Martin

PittGreene

Wilson

NashFranklin

Halifax

Edgecombe

Vance

DurhamAlamance

Cumberland

Washington

Perquimans

Currituck

Chowan

NewHanover

Chatham

Caswell

Union

Mecklenburg

Ashe

Rutherford

Transylvania Cleveland

Alleghany

PasquotankYadkin

Camden

Wayne

Hospitals that have passed a 100% tobacco-free campus wide policy

Hospitals that have publicly announced that they will become 100% tobacco-free campus wide

Hospitals that have not yet passed the 100% tobacco-free campus wide policy

For more information, contact Melva Fager Okun DrPH, NC Prevention Partners, 88 Vilcom Circle, Suite 110, Chapel Hill NC 27514, 919 969-7022 ext. 3#, [email protected]. The Healthy Hospital Initiative is managed by NC Prevention Partners. The initiative is funded by The

Duke Endowment and in partnership with the NC Hospital Foundation.

Last updated on 10/30/06

© 2006 NC Prevention Partners

The Healthy Hospital Initiative supports hospitals to establish campuses that are 100% tobacco-free.

12-month Timeline Month OneCOO of each acute care facility commits to 100% tobacco-free campus wide policyPHS Tobacco Program Strategic Planning session Examine other hospital smoke free policies promotional materials and signage, Establish an Tobacco-Free Policy committee (include at least one tobacco user)

HR, Security, physicians, nursing, pharmacy, health education, PR, community relations, Facilities manager, tobacco cessation expert, and legal counsel

Develop a communication plan and timeline for the coming year.Present to Board of Trustees, get input and notify them of policy development

Month TwoPromotion to current employees about tobacco benefitsDetermine any and all costs of Tobacco-Free policy implementation, submit budget requestsDetermine if we need to expand tobacco benefit coverage (counseling and medication)Ensure that access to medication and counseling is at low or no-cost, renewable every yearEstablish standing orders for counseling and medication for patients in every clinical area (5 A’s)Establish Quit Line Connections from all clinical settings.

Month ThreeReview other hospital’s policies and analyze applicability.Evaluate every aspect of acute care facility where smoking occursCreate list of other buildings and areas to be included in the policy (where you have employees located off-site)Evaluate and Consider employee incentives. Decide if smoking will be available in cars, or if employees will be able to go off-site during breaks.

Month FourWrite policy and present policy to legal counsel for review, changes, and approval.

12-month Timeline Month Five

Develop FAQ sheet

Develop and implement procedure for informing all patients about new policy and cessation benefits

Develop materials for in-take personnel to use when admitting patients

Develop and distribute materials for promoting the Tobacco Quit line.

Develop communication plan for announcing the policy initiative

Month Six

Presentations to all in-house and referring physicians, nurses, and allied professionals

Presentations to all support staff, other employees, and managers

Month Seven

Present the policy to hospital board for discussion and input and sign off.

Inform all employees of the expected policy and solicit their support

Walk campus to determine where signage is needed, including large signs at main entries to the campus.

Develop signage to put tobacco use is allowed and near all cigarette butt receptacles.

Prepare letter from CEO to go out to all employees informing them of the new policy

Prepare promotional campaign for cessation benefits for smokers.

Have hospital PR department begin outreach to all community media outlets

Graphics for major banner for hanging in main lobby or on side of hospital building at the main entrance.

Develop two sets of signs; one for posting upon passage of the policy and a second set after policy enactment. Signage should be omnipresent, attractive, and bold. You should have a sense of tripping over the signs. Good signage is a fundamental part of communicating the new policy.

Seek input from tobacco users about signage and promotional materials.

Order signage.

12-month Timeline Month Eight

Present the policy to hospital board of trustees for passage.

Mail letter from CEO to all hospital employees.

Mount all signage and banner.

Promote the counseling and tobacco cessation pharmaceutical products and services available to all employees.

Share information on incentives to quit (? lower premiums for health insurance coverage, free resources, $$)

Communicate with and make presentations to community leaders and groups

Medical, civic, governmental, business, and religious organizations.

Meet with media representatives, including editorial boards.

Month Nine

Distribute patient flyers about new policy in all appointment reminders.

Promote tobacco cessation resources – including in-house group and individual sessions

Distribute suggestion boxes in key locations asking for employee suggestions and feedback.

Month Ten

Conduct staff training to prepare management-level staff for the enactment of the new policy.

Develop a program to encourage employees to help and consider rewarding such efforts.

writing a Letter to the Editor

submitting a church bulletin notice

serving as a tobacco quitting buddy

helping to assure the campus is tobacco-butt free

helping with survey of employees about policy

asking for suggestions for improvement

approaching community businesses to donate prizes

12-month Timeline Month Eleven

Repeat promotion of cessation interventions for all tobacco-using employees

Develop patient intake document to verify (signature) that patients are aware of policy

Make copy for patient, family and copy to go into patient folder.

Develop materials for employees to give to tobacco users

Conduct a senior management training session on the new policy.

Begin countdown to launch – ten days out.

Celebrate upcoming new policy with fun event for all employees

Ice cream social

Walk around the campus

Hospital CEO and conducts a Q&A session with all employees

Develop a new FAQ sheet.

Contact, educate, and assist adjacent community neighbors

Work with them on concerns in anticipation of the new policy

Discuss possible impact on their property.

Determine compliance measures

Create job descriptions, expectations, and schedule for ongoing assessment and reporting

Month 12:

GO LIVE

Celebrate with a Large Health Fair on each campus

tobacco cessation

healthy weight

substance abuse prevention

mental health awareness

Potential Pitfalls

• Top level leadership• Clinical champions• Starts and ends with cessation benefits• Link every policy to cessation intervention• Nursing role is crucial• It takes teamwork• Impact on community (neighbors, unions, etc…)• Strong Project Management

Be the change you want to see in the world

Mohandas K. Gandhi (1869-1948)

Thank You

[email protected]

Integrating Tobacco Control into Health Care Delivery Charles J. Bentz, MD, FACP Medical Director:...

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