Vermont Department of HealthVermont Department of HealthChanging to the Minimum Data Changing to the Minimum Data

SetSetfor Evaluation of Quit Line for Evaluation of Quit Line

ServicesServicesPresented By:Presented By:

Todd Hill, LiCSW, LADCTodd Hill, LiCSW, LADCPublic Health Tobacco SpecialistPublic Health Tobacco Specialist

As designed by the American Cancer As designed by the American Cancer Society:Society:

Dr. Vance RabiusDr. Vance Rabius

• The Vermont Department of Health provides free Quit Line services to all smokers living in Vermont through a grant to the American Cancer Society, using funds from the Master Settlement Agreement.

• Quit Line Services have been in place since March of 2001.

• In that time, Quit Line has received more than 7200 calls from Vermonters either personally quitting tobacco or calling for information.

Creation of the VT Tobacco Evaluation and Review Board (VTERB)

VT Statute: “There is created and established, within the office of the secretary, a body to be known as the Vermont tobacco evaluation and review board, an independent state board created to work in partnership with the agency of human services and the department of health in establishing the annual budget, program criteria and policy development, and review and evaluation of the tobacco prevention and treatment programs”.

Vermont’s Process for making changes to the MDS:Vermont’s Process for making changes to the MDS:

• American Cancer Society provided a list of how they proposed implementing the changes from the current survey to the MDS.

• The Vermont Department of Health convened a meeting with the VTERBs Evaluation Committee.

• The Evaluation Committee made recommendations that I reported to ACS.

• ACS then sent to the Evaluation Committee a draft of the proposed script that would be used for intake and follow up calls for final approval.

Members of the VTERB Evaluation CommitteeMembers of the VTERB Evaluation Committee

Dr. John Hughes, MD – Dr. Hughes is on the facility of the Medical School at the University of Vermont. He is a medically trained psychiatrist. Dr. Hughes is a world renown researcher in many aspects of tobacco control.

Dr. Theodore Marcy, MD, MPH – Dr. Marcy is also a member of the Facility at the University of Vermont Medical School. Dr. Marcy splits his time between being a practicing pulmonary physician and conducting tobacco control research, funded by grants from the National Cancer Institute.

Dr. Laura Solomon, Ph.D. – Dr. Solomon is on the facility of the School of Psychology at the University of Vermont. She has been conducting research on Quit Lines and best practices for cessation among pregnant women for 15 years.

Areas of Evaluation of Vermont’s callers Not Affected Areas of Evaluation of Vermont’s callers Not Affected by MDSby MDS

Gender: “I need to verify if you are male or female?”

Age: “What is your date of birth?”

Geographic Location: “What is your postal or zip code?”

Smoking (Tobacco) Intensity: “How many cigarettes, pipes, pouches do you use per day/week?”

Questions at Intake Affected by Questions at Intake Affected by MDSMDS

Health InsuranceHealth Insurance EthnicityEthnicity EducationEducation Age of OnsetAge of Onset ReadinessReadiness AwarenessAwareness

Health InsuranceHealth Insurance

VT CURRENT:VT CURRENT: Health Insurance information only collected if Health Insurance information only collected if client wanted to know about the Nicotine Replacement client wanted to know about the Nicotine Replacement subsidy program.subsidy program.

MDS CHANGES:MDS CHANGES: Asks everyone, “Do you have health Asks everyone, “Do you have health insurance?”insurance?”

FINAL DECISION:FINAL DECISION: Adopt MDS question. Adopt MDS question.

COMMENTS:COMMENTS: Vermont has also decided that it is important for Vermont has also decided that it is important for us to have insurance provider information for all callers. We us to have insurance provider information for all callers. We intend to add a follow up question to gather this intend to add a follow up question to gather this information.information.

EthnicityEthnicity

VT CURRENT:VT CURRENT: “Which of these groups would you say “Which of these groups would you say best describes you?” best describes you?”

MDS CHANGES:MDS CHANGES: “Are you Hispanic or Latino(a)?” “Are you Hispanic or Latino(a)?”

FINAL DECISION:FINAL DECISION: Adopt MDS question. Adopt MDS question.

COMMENTS:COMMENTS: ACS warns that this change may cause ACS warns that this change may cause in increased reporting in Hispanic callers. in increased reporting in Hispanic callers.

EducationEducationVT CURRENT:VT CURRENT: “What is the highest level of education you have “What is the highest level of education you have

completed?”completed?”Categories - No school, 1-5 some grade school, 6-8 some Categories - No school, 1-5 some grade school, 6-8 some

junior high school, 9-11 some high school, GED, HS Grad, junior high school, 9-11 some high school, GED, HS Grad, Some college, Trade school grad, College Grad, Graduate Some college, Trade school grad, College Grad, Graduate School, Refused.School, Refused.

MDS CHANGES:MDS CHANGES: “What is the highest level of education that “What is the highest level of education that you have completed?”you have completed?”

Categories - (USA) Less than grade 9, grade 9-11 (no degree), Categories - (USA) Less than grade 9, grade 9-11 (no degree), GED, HS Grad, Some college, Trade or Tech school, College GED, HS Grad, Some college, Trade or Tech school, College or University Degree.or University Degree.

FINAL DECISION:FINAL DECISION: Keep current question. Keep current question.

Comments:Comments: We will keep old question to preserve historical We will keep old question to preserve historical data. Will take responses and recode into MDS categories.data. Will take responses and recode into MDS categories.

Age of Smoking OnsetAge of Smoking OnsetVT CURRENT:VT CURRENT: “How long have you been “How long have you been

smoking?” smoking?” Categories - <6 months, 6mo to 1 year, 1 to 5 Categories - <6 months, 6mo to 1 year, 1 to 5

years, 6 to 10 years, >10 years.years, 6 to 10 years, >10 years.

MDS CHANGES:MDS CHANGES: “At what age did you start “At what age did you start smoking?”smoking?”

FINAL DECISION:FINAL DECISION: Adopt MDS question. Adopt MDS question.

COMMENTS:COMMENTS: With this open text question we With this open text question we are able to go back and recode data for are able to go back and recode data for historical comparisons if needed.historical comparisons if needed.

Readiness to QuitReadiness to Quit

VT CURRENT:VT CURRENT: “Are you willing to make a serious quit “Are you willing to make a serious quit attempt in the next 30 days.” (yes or no)attempt in the next 30 days.” (yes or no)

MDS CHANGES:MDS CHANGES: “Do you intend to quit in the next 30 “Do you intend to quit in the next 30 days?” (Yes, no, don’t know)days?” (Yes, no, don’t know)

FINAL DECISION:FINAL DECISION: Adopt MDS question. Adopt MDS question.

COMMENTS:COMMENTS: According to Dr. Hughes, the verb According to Dr. Hughes, the verb “intend” represents a lesser commitment than “intend” represents a lesser commitment than “willing”. This may contribute to some false “willing”. This may contribute to some false positives. Additionally, with the MDS the “no” positives. Additionally, with the MDS the “no” answers may not be comparable to historical data, answers may not be comparable to historical data, with the addition of “don’t know”.with the addition of “don’t know”.

Awareness of QuitlineAwareness of QuitlineVT CURRENT:VT CURRENT: “How did you hear of this phone number?” “How did you hear of this phone number?”Categories – Newspaper story, newspaper ad, tv news story, Categories – Newspaper story, newspaper ad, tv news story,

tv ad, radio news story, radio ad, MD, DDS, Pharmacist, tv ad, radio news story, radio ad, MD, DDS, Pharmacist, Nurse, other health care provider, flyer from school, flyer Nurse, other health care provider, flyer from school, flyer from work, flyer from community, friend/relative, from work, flyer from community, friend/relative, internet/website, ACS office, Transfer from NCIC.internet/website, ACS office, Transfer from NCIC.

MDS CHANGES:MDS CHANGES: “How did you hear about the Quitline?” “How did you hear about the Quitline?”Categories – Mass media, other paid advertising, referrals, Categories – Mass media, other paid advertising, referrals,

other.other.

FINAL DECISION:FINAL DECISION: Keep current question. Keep current question.

COMMENTS:COMMENTS: The Board’s committee was concerned about The Board’s committee was concerned about keeping a historical comparison with this question. Our keeping a historical comparison with this question. Our question allows us to be able to recode the data into the question allows us to be able to recode the data into the MDS categories. ACS also has an open text field that allows MDS categories. ACS also has an open text field that allows intake workers to enter responses they do not know how to intake workers to enter responses they do not know how to code, in order to recode later.code, in order to recode later.

Questions asked at Intake and also Questions asked at Intake and also at the 7 month follow-up callat the 7 month follow-up call

affected by MDSaffected by MDS

Type of TobaccoType of Tobacco Level of AddictionLevel of Addiction

Type of Tobacco UsedType of Tobacco Used

VT Current:VT Current: Please select caller’s reason for call: Please select caller’s reason for call:Personally quitting cigarettes, personally quitting Personally quitting cigarettes, personally quitting

smokeless, already quit (cigarettes/smokeless), smokeless, already quit (cigarettes/smokeless), family/friend of current smoker, other (examples: family/friend of current smoker, other (examples: doctors, teachers, community orgs, cigar/pipe doctors, teachers, community orgs, cigar/pipe smokers)smokers)

MDS CHANGES:MDS CHANGES: “Do you currently smoke cigarettes?” “Do you currently smoke cigarettes?”(USA) – everyday, somedays, not at all.(USA) – everyday, somedays, not at all.If yes – “How many do you smoke per day?”If yes – “How many do you smoke per day?”If no – “When was the last time you smoked or used If no – “When was the last time you smoked or used

any other tobacco products?”any other tobacco products?”Ask for all other types of tobacco, cigars, pipes, chew, Ask for all other types of tobacco, cigars, pipes, chew,

snuff, ect.snuff, ect.

Type of Tobacco Used (Continued)Type of Tobacco Used (Continued)

FINAL DECISION:FINAL DECISION: Keep current question and Keep current question and Adopt MDS question.Adopt MDS question.

COMMENTS:COMMENTS: We were concerned about the We were concerned about the respondent burden here, having to go respondent burden here, having to go through all the tobacco types. For practical through all the tobacco types. For practical purposes we decided to adopt the MDS purposes we decided to adopt the MDS question and looked to cut length of intake question and looked to cut length of intake in other areas.in other areas.

Level of AddictionLevel of AddictionVT CURRENT:VT CURRENT: “Do you have a cigarette within the “Do you have a cigarette within the

first 15 minutes after you wake up?”first 15 minutes after you wake up?”

MDS CHANGES:MDS CHANGES: “How soon after you wake up do “How soon after you wake up do you smoke your first cigarette?” (OPEN you smoke your first cigarette?” (OPEN RESPONSE)RESPONSE)

Interviewer codes – within 5 minutes, 6-30 minutes, Interviewer codes – within 5 minutes, 6-30 minutes, 31-60 minutes, greater than 60 minutes.31-60 minutes, greater than 60 minutes.

FINAL DECISION:FINAL DECISION: Adopt MDS question. Adopt MDS question.

COMMENTS:COMMENTS: We requested ACS not to have We requested ACS not to have interviewer recode responses. We want the raw interviewer recode responses. We want the raw data, and will recode on our end. This will help data, and will recode on our end. This will help preserve historical data.preserve historical data.

Questions asked at the 7 month Questions asked at the 7 month follow-up call affected by MDSfollow-up call affected by MDS

Client SatisfactionClient Satisfaction Quit AttemptsQuit Attempts Reduction of Tobacco UseReduction of Tobacco Use SwitchingSwitching Use of pharmaceuticalsUse of pharmaceuticals Quit RatesQuit Rates

Client SatisfactionClient SatisfactionVT CURRENT:VT CURRENT: We are asking 18 client satisfaction questions. We are asking 18 client satisfaction questions.

Many based on a 10 point scale. Satisfaction questions are Many based on a 10 point scale. Satisfaction questions are only asked during the first follow-up period in which we only asked during the first follow-up period in which we contact someone. This could be at 3, 6, or 12 months.contact someone. This could be at 3, 6, or 12 months.

MDS CHANGES:MDS CHANGES: Only one, optional satisfaction question is Only one, optional satisfaction question is asked. “Overall how satisfied were you with the service you asked. “Overall how satisfied were you with the service you received from the quitline?” Callers are asked to rate their received from the quitline?” Callers are asked to rate their response using a Likert scale. (i.e. very satisfied, mostly response using a Likert scale. (i.e. very satisfied, mostly satisfied, satisfied, ect)satisfied, satisfied, ect)

FINAL DECISION:FINAL DECISION: Adopt MDS question. Adopt MDS question.

COMMENTS:COMMENTS: Due to respondent burden, the Board’s Due to respondent burden, the Board’s committee recommended dropping all other satisfaction committee recommended dropping all other satisfaction questions, except this one. Considerations here included, questions, except this one. Considerations here included, difficulty of historical comparisons, as well as ACS concern difficulty of historical comparisons, as well as ACS concern that satisfaction scores become higher using Likert scales.that satisfaction scores become higher using Likert scales.

Quit AttemptsQuit Attempts

VT CURRENT:VT CURRENT: “Since your last contact with the “Since your last contact with the Quitline, have you quit smoking for at least 24 Quitline, have you quit smoking for at least 24 hours?”hours?”

MDS CHANGES:MDS CHANGES: “Since you first called the Quitline “Since you first called the Quitline on (Date of First Contact), 7 months ago, did you on (Date of First Contact), 7 months ago, did you quit using tobacco for 24 hours or longer?”quit using tobacco for 24 hours or longer?”

FINAL DECISION:FINAL DECISION: Adopt MDS question. Adopt MDS question.

COMMENTS:COMMENTS: We did not choose to add the optional We did not choose to add the optional question, “How many times did you quit for 24 question, “How many times did you quit for 24 hours or longer?”hours or longer?”

Reduction in the Amount of Tobacco Reduction in the Amount of Tobacco UseUse

VT CURRENT:VT CURRENT: “On average, how many cigarettes do “On average, how many cigarettes do you smoke per day?”you smoke per day?”

MDS CHANGES:MDS CHANGES: MDS asks also about cigars, pipes, MDS asks also about cigars, pipes, and smokeless.and smokeless.

FINAL DECISION:FINAL DECISION: Adopt MDS changes. Adopt MDS changes.

COMMENTS:COMMENTS: The Board is concerned about The Board is concerned about respondent burden here, as switching is such a respondent burden here, as switching is such a limited phenomenon. limited phenomenon.

Switching Forms of Tobacco and Switching Forms of Tobacco and Switching From Daily to Occasional Switching From Daily to Occasional

Use.Use.VT CURRENT:VT CURRENT: “Have you smoked at all in the last 48 hours?” “Have you smoked at all in the last 48 hours?” If no – “Have you smoked at all?”If no – “Have you smoked at all?”If yes – “How many days did you go without smoking?”If yes – “How many days did you go without smoking?” - “On average how many cigarettes do you smoke a day?”- “On average how many cigarettes do you smoke a day?”

MDS CHANGES:MDS CHANGES: “At the current time, how many cigarettes do you “At the current time, how many cigarettes do you smoke per day?” Also the MDS asks for pipe, cigars, and smoke per day?” Also the MDS asks for pipe, cigars, and smokeless. Additionally, they calculate the number of smokers smokeless. Additionally, they calculate the number of smokers switch to another form, and the number of people that switch to switch to another form, and the number of people that switch to becoming occasional smokers.becoming occasional smokers.

FINAL DECISION:FINAL DECISION: Adopt MDS questions. Adopt MDS questions.

COMMENTS:COMMENTS: Dr. Hughes, in his research, has found that switching Dr. Hughes, in his research, has found that switching is a limited phenomenon. The Board’s committee is concerned is a limited phenomenon. The Board’s committee is concerned about the respondent burden to get at a potentially limited about the respondent burden to get at a potentially limited range of behaviors.range of behaviors.

Use of Pharmaceuticals to Help QuitUse of Pharmaceuticals to Help Quit

VT CURRENT:VT CURRENT: “Did you take any medications to help you quit “Did you take any medications to help you quit smoking?” (yes, no, refused)smoking?” (yes, no, refused)

““If so, which ones?” (list) “Any other medications?” (list) Also If so, which ones?” (list) “Any other medications?” (list) Also there is an open text field available to interviewer if there is an open text field available to interviewer if medication is not listed.medication is not listed.

MDS CHANGES:MDS CHANGES: “Since your call to the quitline on (Date of First “Since your call to the quitline on (Date of First Contact), 7 months ago, have you used nicotine replacement Contact), 7 months ago, have you used nicotine replacement (gum or patch) or pills (Zyban) to help you quit?” (Yes, no, (gum or patch) or pills (Zyban) to help you quit?” (Yes, no, refused, don’t know)refused, don’t know)

FINAL DECISION:FINAL DECISION: Adopt MDS question. Adopt MDS question.

COMMENTS:COMMENTS: We also kept the question from our current survey We also kept the question from our current survey where a list of NRT products plus Zyban are read to the caller where a list of NRT products plus Zyban are read to the caller for them to endorse.for them to endorse.

Quit RatesQuit RatesVT CURRENT:VT CURRENT: We use the lead in question of “Since your last We use the lead in question of “Since your last

contact with the quitline, have you quit smoking for at least contact with the quitline, have you quit smoking for at least 24 hours?” Then we ask, “Have you smoked within the last 24 hours?” Then we ask, “Have you smoked within the last 48 hours?” and follow up with “Have you smoked at all?”48 hours?” and follow up with “Have you smoked at all?”

MDS CHANGES:MDS CHANGES: Have you smoked any cigarettes, cigars, pipes Have you smoked any cigarettes, cigars, pipes or used chewing tobacco or snuff in the last 7days?” and or used chewing tobacco or snuff in the last 7days?” and follow up with “…in the last 30 days?” (Yes, no, don’t know, follow up with “…in the last 30 days?” (Yes, no, don’t know, refused) Also interviewer codes a response for each tobacco refused) Also interviewer codes a response for each tobacco use.use.

FINAL DECISION:FINAL DECISION: Adopt MDS question. Adopt MDS question.

COMMENTS:COMMENTS: In order to preserve historical data, we have added In order to preserve historical data, we have added the question from the current survey, “When was the last day the question from the current survey, “When was the last day that you smoked?” We can obtain any type of point that you smoked?” We can obtain any type of point prevalence using this question. This will also be helpful in prevalence using this question. This will also be helpful in preserving data for the yet to be determined continuous preserving data for the yet to be determined continuous abstinence question.abstinence question.

Lessons Learned

• The process will take longer than you plan for.

• It is a good exercise to review the entire body of questions in order to make sure you are getting the data you think you are.

• Try to look for ways to either keep your original questions and roll them up into MDS answers or adopt the MDS questions and be able to roll them up into your historical categories.

• Remember this is a minimum data set, so you can continue to look at your original questions, and coding the data after the survey can help you save historical categories as well.