Transcript Present - LSU Hospitals

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
Age quit
30
40
50
60
Years gained
10
9
6
2
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)
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 2000
Hughes et al, CA cancer journal clinic, 2000 50:143
Providence 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, 1996
Oregon 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: $750
Oregon Tobacco Facts: Department of Human Services, October 2001
Clearing the Air at Work: Orange County Health Care Agency, 1994
Cost of workplace tobacco dependence
$ 7,000,000
$ 6,000,000
$ 5,000,000
$ 4,000,000
$ 3,000,000
$ 2,000,000
$ 1,000,000
1,000
2,000
3,000
4,000
5,000
6,000
Number of employees
Source: Mercer Human Resources Consulting, New York, NY
Cost-Effectiveness
Quist-Paulsen P, et al. Eur J Cardiovasc Prev Rehabil, 2006, 13(2):274-280
Treating tobacco dependence
reduces 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
Community
Hospitals
From the start we need
to strategically partner
to allow for a prevention
focus (vs. treatment)
Acute care is the key
strength of our health
system
Health System
We need to have a
regional focus on every
thing we do. The health
system needs to win.
Target Groups
In addition to population
based efforts, we also
need to target those at
highest risk, employees,
and special populations
Interventions
SMOKER
(who
wants to quit)
We need to put in
place the benefits for
evidence-based
interventions to help
current smokers quit
Providers
We need to have a
dedicated Physician
Champion who can lead
this effort. We also
need provider education
and incentive
Evaluation
We need to make
measuring qualitative
and quantitative
outcomes a priority
Clinics
We need to develop and
implement changes in
infrastructure needed to address
tobacco systematically in clinics
Treating Tobacco Dependence : 1994
SMOKER
(who wants to quit)
Providers
•Physician Leadership
Cessation
•Group Classes
•Pay Full Price
Treating Tobacco Dependence : 1995
Community
Health System
•TOFCO
•Prevention Planning
Target Groups
•PHS employees
Providers
•Physician Leadership
Cessation
SMOKER
(who wants to quit)
•Group Classes
•$5 copay
•Self-Help Materials
Clinics
•EMR Resources
Treating Tobacco Dependence : 1996
Community
•TOFCO
•Legislation
Hospital-Based
•Inpatient Program
•Proposal
Target Groups
•PHS employees
•Population Health Improvement
Cessation
SMOKER
(who wants to quit)
Providers
•Physician Leadership
•5 A’s Training/Education
Health System
•Group Classes
•Self-Help Materials
•NRT Benefit
•Telephone Support
Clinics
Evaluation
•C.O.R.E.
•Utilization
•EMR Resources
•5 A’s Training
Treating Tobacco Dependence : 1997
Community
•TOFCO
•Legislation
•Guideline
Hospital-Based
Health System
•Inpatient Program
•2nd proposal
•PHI funding
•Statewide Guideline
Target Groups
•PHS employees
•Clinical Programs
Cessation
SMOKER
(who wants to quit)
Providers
•Physician Leadership
•5 A’s Training/Education
•Reimbursement
•Group Classes
•Self-Help Materials
•NRT benefit
•Telephone Support
Clinics
Evaluation
•C.O.R.E.
•Utilization
•CQI
•5 A’s Training
•EMR Resources
Treating Tobacco Dependence : 1998
Community
•TOFCO
•Legislation
•Oregon Quit Line
Hospital-Based
Health System
•Inpatient Program
•Behavioral Health/CD
•Funded Research
•$180,000
Target Groups
•Disease Management
•PHS employees
• OMAP Project
Prevention
Cessation
SMOKER
(who wants to quit)
Providers
•5 A’s Training/Education
•Reimbursement
•Physician Leadership
•Group Classes
•Medication benefit
•Telephone Support
•Self-Help Materials
Clinics
Evaluation
•C.O.R.E.
•Programs
•CQI
•5 A’s Training
•EMR Resources
•Resources: Primary Care,
Specialties, Pediatrics, OB/GYN
Treating Tobacco Dependence : 1999
Community
•TOFCO
•Legislation
•Oregon Quit Line
Hospital-Based
Health System
•Inpatient Program
•Behavioral Health/CD
•Funded Research
•$230,000
Target Groups
•Disease Management
•PHS employees
•Primary Care
Cessation
SMOKER
(who wants to quit)
Providers
•5 A’s Training/Education
•Reimbursement
•Physician Leadership
•Group Classes
•Medication benefit
•Telephone Support
•Self-Help Materials
Clinics
Evaluation
•C.O.R.E.
•Programs
•Research
•5 A’s Training
•EMR Resources
•Paper-Based Resources
•Resources: Primary Care,
Specialties, Pediatrics, OB/GYN
Treating Tobacco Dependence : 2000
Community
•TOFCO
•Legislation
•Oregon Quit Line
Hospital-Based
Health System
•Inpatient Program
•Behavioral Health/CD
•Funded Research
•$260,000
•NCQA Accreditation
•1st AAHP Award
Target Groups
•Disease Management
•PHS employees
• Women & Children
Cessation
SMOKER
(who wants to quit)
Providers
•5 A’s Training/Education
•Reimbursement
•Physician Leadership
•Group Classes
•Medication benefit
•Telephone Support
•Self-Help Materials
Clinics
Evaluation
•C.O.R.E.
•Research
•Publications
•5 A’s Training
•EMR Resources
•Resources: Primary Care,
Specialties, Pediatrics, OB/GYN
Treating Tobacco Dependence : 2001
Community
•TOFCO
•Legislation
•Oregon Quit Line
Hospital-Based
Health System
•Inpatient Program
•Behavioral Health/CD
•Funded Research
•$810,000
•2nd AAHP Award
Target Groups
•Disease Management
•PHS employees
• Women & Children
Cessation
SMOKER
(who wants to quit)
Providers
•5 A’s Training/Education
•Reimbursement
•Physician Leadership
•Group Classes
•Medication benefit
•Telephone Support
•Self-Help Materials
Clinics
Evaluation
•C.O.R.E.
•Research
•Publications
•5 A’s Training
•EMR Resources
•Provider feedback
•Resources: Primary Care,
Specialties, Pediatrics, OB/GYN
Treating Tobacco Dependence : 2002
Community
•TOFCO
•Legislation
•Oregon Quit Line
Hospital-Based
Health System
•Inpatient Program
•Behavioral Health/CD
•Research > $800K
•OR DHS Award
•3rd AAHP Award
Target Groups
•Disease Management
•PHS employees
•Women & Children
•Web-Based
Cessation
SMOKER
(who wants to quit)
Providers
•5 A’s Training/Education
•Reimbursement
•Physician Leadership
•Group Classes
•Free Medications
•Telephone Support
•Self-Help Materials
•Prov-RN
Clinics
Evaluation
•C.O.R.E.
•Research
•Publications
•5 A’s Training
•EMR Resources
•Resources: Primary Care,
Specialties, Pediatrics, OB/GYN
Treating Tobacco Dependence : 2003
Community
•TOFCO
•Oregon Quit Line
•Business Case
Hospital-Based
Health System
•Inpatient Program
•Behavioral Health/CD
•Research > $800K
•Leadership: ATMC
RWJF, CDC, AAHP
•H.S.I. Program
Target Groups
•Disease Management
•PHS employees
•Web-Based
•Women & Children
•Clinical Programs
Cessation
SMOKER
(who wants to quit)
Providers
•5 A’s Training/Education
•Reimbursement
•Physician Leadership
•Group Classes
•Free Medications
•Telephone Support
•Self-Help Materials
•Prov-RN
Clinics
Evaluation
•C.O.R.E.
•Utilization
•CQI
•5 A’s Training
•EMR Resources
•Resources: Primary Care,
Specialties, Pediatrics, OB/GYN
Treating Tobacco Dependence : 2004
Community
Hospital-Based
Health System
•Inpatient Program
•Oregon Quit Line
•Behavioral Health/CD
•Make it Your Business
•Statewide Conference
•Research > $800K
•H.S.I. Program
•Leadership: ATMC
AAHP-HIAA
Target Groups
•Disease Management
•PHS employees/policy
•Web-Based
•Women & Children
•Clinical Programs
Cessation
SMOKER
(who wants to quit)
Providers
•5 A’s Training/Education
•Reimbursement
•Physician Leadership
•Group Classes
•Free Medications
•Telephone Support
•Self-Help Materials
•Prov-RN
Clinics
•5 A’s Training
•EMR Resources
•C.O.R.E.
•Clinical programs •Resources: Primary Care,
Evaluation
Specialties, Pediatrics, OB/GYN
•TAR SOFTWARE outreach
Treating Tobacco Dependence : 2005
Community
Hospital-Based
Health System
•Inpatient Program
•Behavioral Health/CD
•Research > $800K
•H.S.I. Program
•Leadership: CMS
•4th National Award
•Oregon Quit Line
•MIYB grant
•TOFCO/Chest Watch
Target Groups
•Disease Management
•PHS campus policy
•Web-Based
•Women & Children
•Clinical Programs
Cessation
SMOKER
(who wants to quit)
Providers
•5 A’s Training/Education
•Reimbursement
•Physician Leadership
•Group Classes
•Free Medications
•Telephone Support
•Self-Help Materials
•Prov-RN
Clinics
•5 A’s Training
•EMR Resources
•C.O.R.E.
•Clinical programs •Resources: Primary Care,
Specialties, Pediatrics, OB/GYN
•Publications
•TAR SOFTWARE outreach
Evaluation
Treating Tobacco Dependence : 2006
Community
•Tobacco Tax
•Oregon Quit Line
•TOFCO (MIYB)
Hospital-Based
Health System
•Inpatient Program
•Behavioral Health/CD
•National Awards
•National Benchmark
•NCQA Accreditation
Target Groups
•PHP Disease Mgmnt
•PHS employees
•Web-Based
•Women & Children
•Clinical Programs (TOP)
Cessation
SMOKER
(who wants to quit)
Providers
•Provider Education
•Reimbursement
•Physician Leadership
•Group Classes
•Free Medications
•Telephone Support
•Self-Help Materials
•Nurse Help Line
Clinics
Evaluation
•Tobacco a QI
•Research
•5 A’s Training
•Electronic Health Record
•Connection to Quit Line
Treating Tobacco Dependence : 2007
Community
•Oregon Quit Line
•TOFCO (MIYB)
•Step Up!
Hospital-Based
Health System
•Inpatient Program
•Behavioral Health/CD
•National Benchmark
•CDC, RWJF, SCLC
•NCQA, ATHC, LA
Target Groups
•Disease Management
•PHS employees
•Web-Based
•Women & Children
•Clinical Programs
Cessation
SMOKER
(who wants to quit)
Providers
•Education
•Reimbursement
•Physician Leadership
•Group Classes
•Free Medications
•Telephone Support
•Self-Help Materials
•Nurse Help Line
Clinics
Evaluation
•Research
•Tobacco as QI
•GWTG, CMS
•5 A’s Training
•Electronic Health Record
•Quit Line Connection
Smoking Prevalence in PHP vs. Oregon
State of Oregon (BRFS)
20
00
20
01
20
02
20
03
9
'9
8
'9
7
'9
6
'9
5
'9
4
'9
3
'9
2
'9
1
'9
0
'9
9
'8
'8
8
24%
23%
22%
21%
20%
19%
18%
17%
16%
15%
Providence Health Plan: Oregon
“The program at
Providence is the
platinum standard
for tobacco cessation
in health systems”
Steve Schroeder MD
Distinguished Professor of Health and Health Care
Director: Smoking Cessation Leadership Center
University 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
Diagram of “Quit
Line Connection”
in Primary Care
Program
Free & Clear
or
Local Programs
ADVISE
ASK
ASSESS
Clinic
Tobacco Use
Documented in
Chart
Clinic
Advice to quit and
Stage of readiness to quit
Documented in Chart
Provider refers to Quit Line
ARRANGE
Two Options for
Connection with
Quitline
Oregon Quit Line
After initial smoking cessation
intervention, QuitLine staff refer
patients to appropriate resources
and return fax form to clinic
Patient
Patient completes Form.
Form faxed to Quit Line.
Quit Line contacts patient.
Patient
Brochure given
Patient contacts quitline
at their convenience.
ASSIST
Bentz CJ, et al. American Journal of Preventive Medicine,2006. 30(1): 31-37.
Paper Quit Line Electronic Quit Line
Fax Form
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”
Type of
Connection
Physician Office
Year 1
Cost per
connect
$15-38
Comment
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.
Am J Prev Med 2006;30(1
Website: www.mytfl.org
Louisiana Tobacco Quit Line
In operation since September 2000
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 23:00
Tues
6:00 to 23:00
Wed
6:00 to 23:00
Thurs
6:00 to 23:00
Fri
6:00 to 20:00
Sat
8:00 to 18:00
Sun
8:00 to 18:00
Live pickup of incoming calls:
Mon
24 hours
Tues
24 hours
Wed
24 hours
Thurs
24 hours
Fri
24 hours
Sat
24 hours
Sun
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, PhD
Erik Bergstrom
Kerry Bonin, MPH
Nancy Davis, MPH
Lori Fleming
Jack Hollis, PhD
Jacquelyn Hunt, PharmD
Benjamin H. LeBlanc, MD
Timothy McAfee, MD, MPH
Joseph Siemienczuk, MD
Feedback Study: Design
Intervention:
20 EMR Clinics:
Quitline Connection
Training in 5 A’s
Matched based on
Clinic Size, Payor mix,
Baseline Ask rates
R
Monthly Feedback
on 5 A’s that are
documented in EMR
Control:
No Feedback
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 statelevel 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/classes
or call the Providence Resource Line at 503-574-6595
Inpatient Smoking Cessation
ACCESS SERVICES
Systematic Identification of Current Smokers
Ask
Every patient asked "Have you smoked in the past year?"
RESPIRATORY CARE
Daily Census of Inpatient Smokers
Printed every morning in Respiratory Care Department
INTERVENTION
Assessment by Trained Therapist
"Do you need help while in Hospital?"
"Are you interested in remaining Smoke-Free?"
Advise
Assess
Assist
Intervention
Resources
Pharmacotherapy
Notification of PCP
Motivational
Cognitive / Behavioral
"Survival Kit"
Referral Information
Pre-printed Order Set
NRT/ Non-nicotine
Personal Letter
Resources
Arrange
It starts at admitting…
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Tobacco Use Status Ascertainment at Admission:
Portland Service Area Hospitals
100%
80%
60%
40%
20%
0%
PMH
PPMC
PSVMC
Providence
Tobacco
Dependent
Patient
Dosing
Guideline
Systematic vs. Non-Systematic:
PHS Inpatient Cessation Program
10000
8000
6000
4000
2000
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Inpatient smokers counseled in 3 PSA hospitals
Data: HBOC
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
The Healthy Hospital Initiative supports hospitals to
establish campuses that are 100% tobacco-free.
Last updated on 10/30/06
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Tyrrell
Wake
Buncombe
Davidson
McDowel
Wilson
Chatham
Randolph
Catawba
Rowan
Haywood
l
Pitt
Beaufort
Swain
Hyde
Lincoln
Greene
Johnston
Graham
Rutherford
Lee
Henderson
Cabarrus
Moore
Jackson
Harnett
Wayn
Gaston
Transylvania Polk
Cleveland
Montgomery
Lenoir Craven
Cherokee
e
Macon
Stanly
Clay
Pamlico
Mecklenbur
Cumberland
Jones
Richmond
g
Sampson
Hoke
Anson
Union
Duplin
Carteret
Hospitals that have passed a 100%
Scotland
Onslow
tobacco-free campus wide policy
Hospitals that have publicly
announced that they will become
100% tobacco-free campus wide
Robeson
Bladen
Pender
Columbus
Brunswick
Hospitals that have not yet passed the
100% tobacco-free campus wide
policy
Dare
New
Hanover
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.
© 2006 NC Prevention Partners
12-month Timeline
Month One
COO of each acute care facility commits to 100% tobacco-free campus wide policy
PHS 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 Two
Promotion to current employees about tobacco benefits
Determine any and all costs of Tobacco-Free policy implementation, submit budget requests
Determine 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 year
Establish standing orders for counseling and medication for patients in every clinical area (5 A’s)
Establish Quit Line Connections from all clinical settings.
Month Three
Review other hospital’s policies and analyze applicability.
Evaluate every aspect of acute care facility where smoking occurs
Create 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 Four
Write 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
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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]