Overview

In 2000, the U.S. Public Health Clinical Practice Guidelines for Treating Tobacco Use and Dependence recommended using a systems approach to address tobacco use with patients. The guideline encouraged healthcare organizations to integrate tobacco cessation treatment into the routine of care. However, making systems changes to address tobacco cessation continues to be a challenge among healthcare organizations.

In order to increase the likelihood that tobacco cessation was addressed as part of the routine of care in healthcare organizations, the Washington State Department of Health conducted a Systems Change Pilot Project with the Tobacco Cessation Resource Center (TCRC), a training and outreach contract held by Free & Clear, Inc. The pilot project, which occurred in 2006 and 2007, used the Chronic Care Model and the Model for Improvement, two theoretical frameworks that have been successfully employed to conduct systems changes to address other chronic conditions, to promote updates in the tobacco treatment protocols in three diverse health delivery organizations.

Design

Participating sites were recruited among organizations that varied in their geographic locations in Washington, but that had previously conducted system-wide changes to address a chronic disease. Site teams included a Washington State Department of Health tobacco contractor and a clinical member of the participating organization. After site teams were trained on the models, they conducted a baseline assessment of the organization to determine the best way to develop a sustainable tobacco treatment system. The teams identified existing resources and barriers to implementing changes and then conducted plan-do-study-act tests to test system changes that incorporated tobacco use documentation into the routine health services provided.

Conclusion

Clinics are open to system changes to support tobacco cessation, but the changes won’t occur without some encouragement. Most health care organizations will require intervention to initiate the changes necessary for instituting routine tobacco cessation even when an organization has experience with system changes. Creating a system-wide protocol for the collection of tobacco use status can be complicated when different types of EMR software or registry protocols are in use for different diseases, however, collecting tobacco use status doesn’t necessarily disrupt regular services and should be documented as a vital sign. Finally, Organizations who already have strong systems in place still need support to ensure sustainability of their existing protocols.